Compositions and methods for treating hair loss

ABSTRACT

The present invention provides methods for treating hair loss, treating, inhibiting, or suppressing a degenerative skin disorder, treating androgenetic alopecia (AGA), generating new hair follicles (HF), and increasing the size of existing HF. The methods comprise epidermal disruption or administration of wnt, a fibroblast growth factor-9 polypeptide or another compound that upregulates sonic hedgehog gene signaling.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application of U.S. patentapplication Ser. No. 16/004,277, filed Jun. 8, 2018, which is acontinuation application of U.S. patent application Ser. No. 14/505,970,filed Oct. 3, 2014, which is a continuation application of U.S. patentapplication Ser. No. 13/129,100, filed Aug. 2, 2011, now issued as U.S.Pat. No. 8,871,711, which is a National Phase Application of PCTInternational Application PCT/US09/64049, filed Nov. 11, 2009, whichclaims priority to and the benefit of U.S. Provisional PatentApplication 61/114,028, filed Nov. 12, 2008. This application is also acontinuation application of U.S. patent application Ser. No. 16/222,705,filed Dec. 17, 2018, which is a continuation of U.S. patent applicationSer. No. 14/946,512, filed on Nov. 19, 2015, which is a continuation ofU.S. patent application Ser. No. 13/327,611, filed on Dec. 15, 2011,which is a continuation of U.S. patent application Ser. No. 11/887,104,filed Sep. 25, 2007, which is a National Phase Application of PCTInternational Application PCT/US06/11319, filed Mar. 28, 2006, claimingpriority to U.S. Provisional Patent Applications 60/665,857 and60/683,293, filed 29 Mar. 2005, and 23 May 2005, respectively.Additionally, this application relates to U.S. patent application Ser.Nos. 12/904,822 and 12/904,981, both filed on Oct. 14, 2010. All of theabove-identified applications are incorporated by reference herein intheir entirety.

GOVERNMENT INTEREST STATEMENT

This invention was made with government support under grant numberAR046837 awarded by the National Institutes of Health. The United Statesgovernment has certain rights in the invention.

FIELD OF THE INVENTION

The invention relates to pharmaceutical compositions and methods fortreating hair loss or regenerating hair follicles.

BACKGROUND OF THE INVENTION

Follicular neogenesis is defined as the generation of new hair follicles(HF) after birth. Humans are born with a full complement of HF, whichcan change in size and growth characteristics as in early baldness orcan ultimately degenerate and disappear as in late stages of baldness orin permanent scarring (cicatricial) alopecias. Therefore, the generationof new HF is desirable in the treatment of common baldness as well asless common hair loss conditions, such as discoid lupus erythematosis,congenital hypotrichosis, lichen planopilaris and other scarringalopecias.

SUMMARY OF THE INVENTION

The present invention provides methods of treating hair loss, treating,inhibiting, or suppressing a degenerative skin disorder, and treatingandrogenetic alopecia (AGA) in a subject and generating new hairfollicles (HF) and increasing the size of existing HF, comprisingepidermal disruption or administration of wnt, and administration of afibroblast growth factor-9 polypeptide or another compound thatupregulates sonic hedgehog gene signaling.

Thus, in one embodiment, the present invention provides a method oftreating hair loss in a subject comprising the steps of (a) disruptingthe epidermis in the region of said hair loss in said subject and (b)administering a composition comprising a fibroblast growth factor-9polypeptide to said subject.

In one embodiment, the hair loss is due to androgenetic alopecia (AGA).In one embodiment, the AGA is male pattern baldness. In anotherembodiment, the AGA is female pattern baldness. In one embodiment, thehair loss is the result of a skin injury. In one embodiment, the hairloss is in the scalp or eyebrow of said subject. In one embodiment, thehair loss is in scarred skin tissue of said subject. In one embodiment,the step of administering is performed 3-12 days after said step ofdisrupting. In one embodiment, the step of disrupting is performed byexposing the region of said hair loss to a mechanical, chemical, oroptical stimulus. In one embodiment, the optical stimulus is radiation.In one embodiment, the administering step is via topical administration.In another embodiment, the administering step is via subepidermaladministration.

In another embodiment, the present invention provides a method forgenerating a hair follicle in the dermis of a subject with hair losscomprising the steps of (a) disrupting the epidermis in the region ofsaid hair loss in said subject and (b) administering a compositioncomprising a fibroblast growth factor-9 polypeptide to said subject.

In another embodiment, the present invention provides a method forincreasing the size of a hair follicle in the dermis of a subject withhair loss comprising the steps of (a) disrupting the epidermis in theregion of said hair loss in said subject and (b) administering acomposition comprising a fibroblast growth factor-9 polypeptide to saidsubject.

In another embodiment, the present invention provides a method forincreasing hair follicle formation in the skin of a subject with hairloss comprising the steps of (a) disrupting the epidermis in the regionof said hair loss in said subject and (b) administering a compositioncomprising a fibroblast growth factor-9 polypeptide to said subject.

In another embodiment, the present invention provides a method fortreating, inhibiting, or suppressing a degenerative skin disordercomprising the steps of (a) disrupting the epidermis in the region ofsaid degenerative skin disorder in said subject and (b) administering acomposition comprising a fibroblast growth factor-9 polypeptide to saidsubject.

In another embodiment, the present invention provides a method fortreating an androgenetic alopecia (AGA) in a scalp of a subjectcomprising the steps of (a) disrupting the epidermis in the region ofsaid AGA in said subject and (b) administering a composition comprisinga fibroblast growth factor-9 polypeptide to said subject.

In another embodiment, the present invention provides a method oftreating hair loss in a subject comprising the step administering acomposition comprising a fibroblast growth factor-9 polypeptide and awnt polypeptide to said subject.

In another embodiment, the present invention provides a method forgenerating a hair follicle in the dermis of a subject comprising thestep of administering a composition comprising a fibroblast growthfactor-9 polypeptide and a wnt polypeptide to said subject.

In another embodiment, the present invention provides a method forincreasing the size of a hair follicle in the dermis of a subjectcomprising the step of administering a composition comprising afibroblast growth factor-9 polypeptide and a wnt polypeptide to saidsubject.

In another embodiment, the present invention provides a method forincreasing hair follicle formation in the skin of a subject comprisingthe step of administering a composition comprising a fibroblast growthfactor-9 polypeptide and a wnt polypeptide to said subject.

In another embodiment, the present invention provides a method fortreating, inhibiting, or suppressing a degenerative skin disordercomprising the step of administering a composition comprising afibroblast growth factor-9 polypeptide and a wnt polypeptide to saidsubject.

In another embodiment, the present invention provides a method fortreating an androgenetic alopecia (AGA) in a scalp of a subjectcomprising the step of administering a composition comprising afibroblast growth factor-9 polypeptide and a wnt polypeptide to saidsubject.

In another embodiment, the invention provides a method of treating hairloss in a subject, the method comprising: administering an effectiveamount of a compound or factor that upregulates sonic hedgehog (SHH)(e.g., SHH agonist) to said subject, thereby treating said hair loss insaid subject. In some embodiments, the method comprises the steps of:wounding a region of said hair loss in said subject; and administeringsaid effective amount of said SHH agonist to the wounded area of saidsubject.

In another embodiment, the invention provides a method of increasing thenumber of hair follicles in a subject, the method comprising:administering an effective amount of a compound or factor thatupregulates sonic hedgehog (SHH) (e.g., SHH agonist) to said subject,thereby treating increasing the number of hair follicles in saidsubject. In some embodiments, the method comprises the steps of:wounding a region of said hair loss in said subject; and administeringsaid effective amount of said SHH agonist to the wounded area of saidsubject.

In another embodiment, the present invention provides a method oftreating hair loss in a subject comprising the steps of (a) disruptingthe epidermis in the region of said hair loss in said subject and (b)administering a composition comprising a compound or factor thatupregulates sonic hedgehog (SHH) to said subject.

In another embodiment, the present invention provides a method forgenerating a hair follicle in the dermis of a subject comprising thesteps of (a) disrupting the epidermis in the region of said hair loss insaid subject and (b) administering a composition comprising a compoundor factor that upregulates sonic hedgehog (SHH) to said subject.

In another embodiment, the present invention provides a method forincreasing the size of a hair follicle in the dermis of a subjectcomprising the steps of (a) disrupting the epidermis in the region ofsaid hair loss in said subject and (b) administering a compositioncomprising a compound or factor that upregulates sonic hedgehog (SHH) tosaid subject.

In another embodiment, the present invention provides a method forincreasing hair follicle formation in the skin of a subject comprisingthe steps of (a) disrupting the epidermis in the region of said hairloss in said subject and (b) administering a composition comprising acompound or factor that upregulates sonic hedgehog (SHH) to saidsubject.

In another embodiment, the present invention provides a method fortreating, inhibiting, or suppressing a degenerative skin disordercomprising the steps of (a) disrupting the epidermis in the region ofsaid hair loss in said subject and (b) administering a compositioncomprising a compound or factor that upregulates sonic hedgehog (SHH) tosaid subject.

In another embodiment, the present invention provides a method fortreating an androgenetic alopecia (AGA) in a scalp of a subjectcomprising the steps of (a) disrupting the epidermis in the region ofsaid hair loss in said subject and (b) administering a compositioncomprising a compound or factor that upregulates sonic hedgehog (SHH) tosaid subject.

Other features and advantages of the present invention will becomeapparent from the following detailed description examples and figures.It should be understood, however, that the detailed description and thespecific examples while indicating preferred embodiments of theinvention are given by way of illustration only, since various changesand modifications within the spirit and scope of the invention willbecome apparent to those skilled in the art from this detaileddescription.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1. FGF9 is expressed during inductive period of hair follicleregeneration at Day 1 after scab detachment (SD). The ratio of FGF9 mRNAcompared to control mRNA expression q-PCR of FGF9 mRNA expression inregenerated epidermis is presented.

FIG. 2. γδTCR immunostaining of regenerated epidermis (SD7, wholemount)(×200) and FGF9 immunostaining of SD1 sample (frozen section) (×400).

FIG. 3. γδTCR & FGF9 immunostaining of regenerated epidermis for SD1sample.

FIG. 4. γδTCR & FGF9 immunostaining of E14 embryonic skin.

FIG. 5. Specificity of anti-FGF9 neutralization antibody for E14.5 mouseembryonal whole lysate (lanes 1 and 2) and for recombinant hFGF9 (+).

FIGS. 6A-6C. Anti-FGF9 neutralization experiment in 3 week-old C57BL/6mice. (FIG. 6A) Treatment schedule in which 50 μl of 10 μg/ml anti-FGF9or IgG2a isotype control were injected subepidermally on scab detachmentday (SD)1-SD4, and tissue was sampled at SD5. (FIG. 6B) Hair folliclenumbers after anti-FGF9 or IgG2a control injections in mice using thetreatment protocol described in (FIG. 6A). (FIG. 6C) Diagram showinginjection site.

FIG. 7. Hair follicle number in anti-FGF9-treated mice vs controls atvarious stages of hair follicle development, as described in Paus R, etal. J Invest Dermatol 1999).

FIG. 8. Model showing how hair germ counting was conducted per mm² at 3different fields per each sample.

FIG. 9. rhFGF9 treatment for three days in embryonic skin explantculture (E13.5). Cultures were treated with 10, 20, or 40 ng/mL ofrhFGF9 or control buffer for three days, and hair germ number/mm² wasevaluated as described in FIG. 8. Mean±SD. *: P<0.05, **: P<0.01,compared to control. EDA-A1 (50 ng/ml) was used as a positive controlfor hair germ number.

FIG. 10. Immunohistochemical staining showing alkaline phosphatasestaining of the dermis in control and rhFGF9 (10, 20, 40 ng/ml)-treatedembryonic skin explants.

FIG. 11. Anti-FGF9 neutralizing antibody treatment for three days inembryonic skin explant culture (E13.5). Cultures were treated with 10,20, or 40 μg/mL of anti-FGF9 neutralizing antibody or control for threedays, and hair germ number/mm² was evaluated as described in FIG. 8.

FIG. 12. Immunohistochemical staining showing K17 staining of theepidermis in control and anti-FGF9 (10, 20, 40 μg/ml)-treated skinexplants.

FIG. 13. Immunohistochemical staining showing alkaline phosphatasestaining of the dermis in control and anti-FGF9 (10, 20, 40μg/ml)-treated embryonic skin explants.

FIG. 14. Effect of 24 h treatment using rhFGF9 (10, 20, 40 ng/ml) onmarkers of embryonic hair follicle development sonic hedgehog (Shh),Ptch1, and Ptch2 by qPCR.

FIG. 15. Effect of 24 h treatment using rhFGF9 (10, 20, 40 ng/ml) onmarkers of embryonic hair follicle development Gli1 and Gli2 by qPCR.

FIGS. 16A-16H. Fgf9 is expressed during HFN initiation and is importantto HFN. (FIG. 16A) Fgf9 is highly expressed in regenerated epidermisprior to hair follicle formation at Day 1 and 3 after reepithelizationwith scab detachment (SD) and decreased to basal level at Day 5. Theratio of Fgf9 mRNA expression in regenerated epidermis was compared tothe level of unwounded epidermis, Day 0. *: P<0.05, **: P<0.01,mean±standard deviation. (FIG. 16B) Effect of FGF9 neutralization on HFNafter wounding in 3-week old mice. The number of regenerated hairfollicles was significantly decreased in the mice treated with anti-FGF9neutralizing antibody compared to controls. **: P<0.05 (FIG. 16C)Determination of developmental stages of hair follicles. Hair folliclesin the anti-FGF9-treated mice showed delay in hair follicle maturation.(C-E) Wholemount hair follicle neogenesis assay stained for KRT17protein and (F-H) alkaline phosphatase activity in separated epidermisand dermis at Day 5 after reepithelization, respectively. Overexpressionof Fgf9 in K14rtTA; TRE-Fgf9-IRES-eGfp mice resulted in increasednumbers of hair follicles at Day 17 after wounding. Scale bar, 1 mm.

FIG. 17. FGF9 is expressed by activated DETC (A) Double immunostainingfor FGF9 and γδ TCR. Fgf9expression in repopulated γδ TCR-positive DETCsafter reepithelization. Dot line, basement membrane. Scale bar, 50 μm.(B) Fgf9 gene expression is highly upregulated in the isolated DETCsafter activationwith mIL-2 and anti-CD3.

FIGS. 18E-18H. Hair follicle neogenesis in TCRd−/− mice is severelyimpaired. (A-D) Wholemount epidermal and dermal samples treated todetect KRT17 protein and (E-H) alkaline phosphatase activity at Day 5after reepithelization. Hair follicle formation was significantlyimpeded in 8 week and 40 week old mice. Scale bar, 1 mm. *: P<0.05,mean±standard error.

FIG. 19. Developmental stages of HFs in control and anti-fgf9antibody-treated wounds.

FIG. 20. FGF9 expression in K14rtTA; TRE-fgf9-IRES-eGfp mice compared tocontrol mice during 2 days of doxycycline treatment.

FIGS. 21A-21C. FGF9 expression in DETCs. (A) FGF9 is highly expressed insuprabasal dendritic cell. Wholemount double immunostaining of FGF9 andγδ TCR of ear epidermis from wild-type mouse without (B) or with IL-2incubation (C).

FIG. 22. FGF9 expression in FGF9^(flox/flox);lck-cre mice compared toFGF9^(flox/flox) control.

FIGS. 23A-23J. Shh signaling is necessary for HFN following injury. aX-gal staining of large wound (LW) and small wound (SW) from ofGli1-LacZ mice at indicated time (n=2-4 W (2-5M) per condition). bqRT-PCR for Shh expression in SW and LW of wild-type mice at 7 daysafter complete re-epithelialization (n=2-6 W(2 M) per condition). cImmunohistochemistry of Shh on SW and LW of wild-type mice at 7 daysafter complete re-epithelialization. *Indicates nonspecific signals. d-fK14-CreER; Shh fl/fl (K14-Shh fl/fl) and littermate control mice weresubjected to large wound (LW) and treated with TAM from PW3d untiltissue harvest at PW21d (n=11-12 W (11-12 M) per condition). Whole-mountHFN assay (d) and quantifications (e, f). g-j Pdgfra-CreER; Smo fl/fl(Pdgfra-Smo fl/fl) and littermate controls were subjected to large wound(LW) and were treated with TAM from 3 or 4 weeks before wounding untiltissue harvest at PW21d (n=3-5 W (3-5M) per condition). Whole-mount HFNassay (g, i) and quantifications (h, j). n: number of wounds (W) or mice(M), Data are represented as mean±s.d., *p<0.05; **p<0.01; ***p<0.001;Student's t-test, Dashed white circle: wound boundary, dashed line:epidermis-dermis border, DP dermal papilla, AP alkaline phosphatase, FEfollicular epithelium, PW post-wound, Scale bars represent 500 μm (a(whole mount), d, g, i), 50 μm (a (section), c)

FIGS. 24A-24K. Epidermal Shh is capable of regenerating HF in woundswithout alteration of collagen. a, b K14-CreER; LSL-Shh; Gli1-LacZ(K14-Shh-Gli1-LacZ) and littermate controls with Gli1-LacZ weresubjected to SW and treated with TAM from PW1d until tissue harvest atindicated time (n=12 W (4M) per condition). X-gal staining was analyzedat PW16d (a), and PW35d (b). Arrowheads show regenerated HFs (b). c-eDistribution of regenerated DP was analyzed from three representativeLWs of K14-CreER; LSL-Shh (K14-Shh) and littermate controls treated withTAM from PW3d until tissue harvesting at PW35d (n=9 W(9 M) percondition). AP+DP in each picture were converted into dots with threedifferent colors (red, green, and cyan) and merged into one picture (c,right). The original images and the corresponding colors represented inthree columns on the left (c). Quantifications of AP+DP per wound (d)and area occupied by DP (e). “Area occupied by DP” was defined bydrawing a line that connects the outermost regenerated DP in wound. f-kK14-CreER; LSL-Shh (K14-Shh) and littermate controls were subjected toSW and treated with TAM from PW1d until tissue harvest at indicatedtime. RNA-seq analyses at PW11d showing heatmap of differentiallyexpressed genes for K14-Shh and control mice (f, g). Red and greencorrespond to high and low expression levels, respectively (n=12 W (4M)per condition). Hydroxyproline assay to measure collagen contents atPW11d (n=12 W (4M) per condition) (h). Diameter of collagen fiber atPW30d (TEM images on the left, n=2 W (2 M) per condition) (i). Detectionof collagen fiber by Masson's trichrome staining (j) and Picrosirius redstaining (k) at PW1 d and PW35d (insets). n: number of wounds (W) ormice (M), Data are represented as mean±s.d., **p<0.01; ***p<0.001; ns:non-significant; Student's t-test, Zigzag line and dashed white circle:wound boundary, Dashed line: epidermis-dermis border, SW small wound, LWlarge wound, PW post-wound, DP dermal papilla, AP alkaline phosphatase,FE follicular epithelium. Scale bars represent 500 μm (b (whole mount),c), 50 μm (b (section), j, k), 10 μm (a), 100 nm (i).

FIGS. 25A-25N. Dermal Hh activation is sufficient to promote HFN innon-regenerative wounds. A Detection of tomato reporter on SW ofSM22-rtTA; tetO-Cre; R26-Tomato mice at indicated time. b-n SM22-rtTA;tetO-Cre: R26-SmoM2 (SM22-SmoM2) and littermate controls were subjectedto SW and treated with doxycycline from PW1d until tissue harvest atPW30d (n=18 W (4-5M) per condition). Whole-mount HFN assay (b, d) andquantifications (c, e). Percentage of AP+DP with K17+FE (f). Percentageof K17+HF with hair shaft (HS) (g). Immunohistochemistry with indicatedmarkers (h-m) and H&E (n). n: number of wounds (W) or mice (M), Data arerepresented as mean±s.d., *p<0.05; Student's t-test, Dashed whitecircle: wound boundary, Dashed line: epidermis-dermis border, SW smallwound, PW post-wound, DP dermal papilla, AP alkaline phosphatase, FEfollicular epithelium, HF hair follicle, HS hair shaft, Bu bulge stemcell area, SG sebaceous gland. Scale bars represent 500 m (b, d), 100 μm(n (Control)), 10 μm (a, h-m, n (SM22-SmoM2)

FIGS. 26A-26J. Dermal Hh activation induces DP fate in woundfibroblasts. scRNA-seq was performed with Tomato+ cells isolated fromwound dermis of both SM22-rtTA; tetO-Cre; R26 SmoM2/Tomato (SM22-SmoM2)and SM22-rtTA; tetO-Cre; R26-Tomato (control) mice 3 days after completere-epithelialization. The mice were subject to SW and treated withdoxycycline from PW1d until PW12d (n=12-25 W(3-5M) per condition). a-itSNE plots of 4680 SM22+ dermal cells split between control and Hhactivated conditions. tSNE plot of SM22+ dermal cells colored byassigned lineages (a). tSNE plot of SM22+ dermal cells according tolineage-specific markers (b-f). tSNE plot of SM22+ dermal cellsaccording to Hh pathway components (g). tSNE plot of SM22+myofibroblasts according to Hh pathway components (h). tSNE plot ofSM22+ myofibroblasts according to cell origin (i). j Heatmap showing theexpression of DP signature genes. Yellow and black/purple correspond tohigh and low expression levels, respectively.

FIGS. 27A-27L. Dermal Wnt activation alone is not sufficient for HFN. aViolin plots of Wnt pathway related genes in SM22+ myofibroblasts. bX-gal staining in epidermis and dermis of SW of Axin2-LacZ mice at PW10dand PW32d. c-h SM22-rtTA; tetO-Cre; β-catenin fl(ex3)/+(SM22-ex3) andlittermate controls were subjected to SW and treated with doxycyclinefrom PW1d until tissue harvest at PW30d (n=3-4 W (3-4M) per condition).Whole-mount HFN assay (c) and quantifications (d, e). H&E (f, g) andAP/Lef1 staining (h) show lack of hair germ (HG) formation by β-cateninactivation in dermis. i-l SM22-rtTA; tetO-Cre; Wls fl/fl (SM22-Wlsfl/fl) and littermate controls were subjected to LW and treated withdoxycycline from PW3d until tissue harvest at PW21d (n=4-5 W (4-5M) percondition). Whole-mount HFN assay (i, k) and quantifications (j, 1). n:number of wounds (W) or mice (M), Dashed white circle and zigzag line:wound boundary, Dashed line: epidermis-dermis border, SW small wound, LWlarge wound, AP alkaline phosphatase, PW postwound, Scale bars represent500 μm (b, c, i, k), 100 μm (f), 50 μm (g, h).

FIGS. 28A-28F. Hh activation can convert fibrotic Wnt-active dermalcells into DP in wounds. a-d Axin2 CreER; R26-SmoM2 (Axin2-SmoM2) andlittermate controls were subjected to SW and treated with TAM from PW1duntil tissue harvest at PW30d (n=9-15 W (3-5M) per condition).Whole-mount HFN assay (a) and quantifications (b, c). H&E andimmunohistochemical analyses with indicated markers (d). e Tracing oftomato-labeled Axin2+ cells in Axin2-CreER; R26-Tomato (Axin2-Tom).Axin2-Tom mice were subjected to LW and treated with TAM from PW3d untilPW12d (before complete re-epithelialization). Tissue was harvested atPW23d and stained with anti-RFP antibody. f Model: Conversion of woundrepair to regeneration in adult skin. Wound healing in mammalian skintypically results in scarring and lack of appendage regeneration. DermalHh activation can install de novo dermal papilla into wounds, resultingin regenerative HF neogenesis, despite collagen deposition in adultwounds. n: number of wounds (W) or mice (M), Data are represented asmean±s.d., **p<0.01, ***p<0.001; Student's t-test, Dashed white circle:wound boundary, Dashed line: epidermis-dermis border, SW small wound, LWlarge wound, PW post-wound, DP dermal papilla, AP alkaline phosphatase,FE follicular epithelium, HF hair follicle, Scale bars represent 500 μm(a), 10 μm (d, e).

FIG. 29. C57B6, wounded at P21, followed by subcutaneous injection ofHh-Ag from PWD5 to PWD8 increases hair follicle formation.

FIG. 30. Cultured human and mouse dermal cells treated with Shh agonist(i.e., Hh-Ag) showed increased hair follicle (HF) number, relative tocontrol.

FIG. 31. Mouse dermal cells infected with active Smo virus at PO resultin more HF in recon assay. Cultured mouse dermal cells transduced withSmo plus mouse epi.

FIG. 32. Mouse dermal cells infected with active Smo virus at P2 resultin more HF in recon assay. P2 cells typically lose activity as seen incontrol. Smo transduction maintains inductivity.

FIG. 33. DP and DS cells in HFs are made from cultured dermal cells(RFP+) infected with activated Smo.

FIG. 34. Quantitation of recon assay of cultured mouse dermal cellstreated with Shh Ag or infected with active Smo virus. Number of hairformed per assay was significantly higher in Shh agonist, Hh-Ag, treatedcells, relative to control and Smo virus infected cells.

FIG. 35. Foreskin dermal cells were infected with active Smo. Humanforeskin dermal cells have no hair inducing activity but activated smoinduces them to promote HF formation.

FIG. 36. Dose dependent response. High concentration of Hh-Ag inhibitedHF formation.

FIG. 37. Mouse neonatal dermal cells were cultured from PO to P2.

FIG. 38. Hair follicles in recon assay using cultured mouse neonataldermal cells.

FIG. 39. Cultured dermal cells from Gli1-Lacz mouse.

FIG. 40. The percentage of Gli1-Lacz positive cells decreased in cultureeven in the presence of Hh-Ag (See Figure X). Culturing dermal cells inthe presence of Hh-Ag does not maintain the Shh responding population.24 hr Shh treatment showed fewer Gli1 positive cells but had similarnumber of HFs in patch assay compared to 7 day treatment.

FIG. 41. Blank-blank best images

FIG. 42. Blank-blank histology.

FIG. 43. Blank-SHH best images

FIG. 44. Blank-SHH histology.

DETAILED DESCRIPTION OF THE PRESENT INVENTION

The invention relates to pharmaceutical compositions and methods fortreating hair loss and regenerating hair follicles. Specifically, theinvention relates to fibroblast growth factor-9 polypeptides andadministering a fibroblast growth factor-9 polypeptide for treating hairloss or regenerating hair follicles.

The present invention provides methods of treating hair loss, treating,inhibiting, or suppressing a degenerative skin disorder, and treatingandrogenetic alopecia (AGA) in a subject and generating new hairfollicles (HF) and increasing the size of existing HF, comprisingepidermal disruption or administration of wnt, and administration of afibroblast growth factor-9 polypeptide or another compound thatupregulates sonic hedgehog gene signaling.

In one embodiment, the present invention provides methods of treatinghair loss, methods for generating a hair follicle, methods forincreasing the size of a hair follicle, methods for treating anandrogenetic alopecia (AGA), methods for arresting alopecia, methods ofreversing alopecia, and methods of depilation comprising administering acomposition comprising a neutralizing fibroblast growth factor-9antibody to a subject.

In another embodiment, a composition or method of the present inventionis utilized on human skin. In another embodiment, the composition ormethod is utilized on an area of unwanted hair growth. In anotherembodiment, the area is the face. In another embodiment, the area is thebikini area. In another embodiment, the area is the legs. In anotherembodiment, the area is the arms. In another embodiment, the area is thechest.

In one embodiment, the methods of the present invention includecontacting a subject with an inhibitor of FGF9, SHH, WNT, or othercompositions for use in the present invention. An “inhibitor” utilizedin methods and compositions of the present invention is, in anotherembodiment, an antibody that binds the protein or biological factor thatis the target of the inhibitor. In another embodiment, the inhibitor isa pharmacologic inhibitor. In another embodiment, the inhibitor is anyother type of inhibitor known in the art. Each possibility represents aseparate embodiment of the present invention.

In one embodiment, the present invention provides a method of treatinghair loss comprising the step of administering a composition comprisinga fibroblast growth factor-9 polypeptide to a subject.

In one embodiment, the present invention provides a method of treatinghair loss in a subject comprising the steps of (a) disrupting theepidermis in the region of said hair loss in said subject and (b)administering a composition comprising a fibroblast growth factor-9polypeptide to said subject.

In another embodiment, the present invention provides a method oftreating hair loss in a subject comprising the step administering acomposition comprising a fibroblast growth factor-9 polypeptide and awnt polypeptide to said subject.

In another embodiment, the present invention provides a method fortreating an androgenetic alopecia (AGA) in a scalp of a subjectcomprising the steps of (a) disrupting the epidermis in the region ofsaid AGA in said subject and (b) administering a composition comprisinga fibroblast growth factor-9 polypeptide to said subject.

In another embodiment, the present invention provides a method fortreating an androgenetic alopecia (AGA) in a scalp of a subjectcomprising the step of administering a composition comprising afibroblast growth factor-9 polypeptide and a wnt polypeptide to saidsubject.

In another embodiment, the present invention provides a method oftreating hair loss in a subject comprising the steps of (a) disruptingthe epidermis in the region of said hair loss in said subject and (b)administering a composition comprising a compound or factor thatupregulates sonic hedgehog (SHH) to said subject.

In one aspect, the invention relates to a method of treating a hair lossin a subject. In another aspect, the invention relates to a method ofincreasing the number of hair follicles in a subject. The methodcomprises the step of administering an effective amount of a sonichedgehog (SHH) agonist to the subject. In some embodiments, the methodcomprises the steps of: wounding a region of the hair loss andadministering the SHH agonist to the wounded region. The wounding stepcan be performed, for example, by disrupting a dermis or an epidermis inthe region of the hair loss.

Any SHH agonist known to one of skilled in the art can be used. Examplesof Shh agonists include, but not limited to, Hh-Ag, Purmorphamine, SAG,and 20(S)-Hydroxycholesterol.

In a particular embodiment, the SHH agonist is Hh-Ag. Hh-Ag (also knownas Hh-Ag1.5) is a small-molecule chemical agonist of Smoothened (Smo)receptor and is an activator of sonic hedgehog (Shh) signaling. It isderived from an initial synthetic hit compound “Hh-Ag1.1”, and optimizedto achieve the activity IC50=1 nM for agonist activity. This molecule iscommercially available for research use and being sold by Cellagentech,Inc. Its molecular formula is C₂₈H₂₆N₃OS, CAS number is 612542-14-0, andchemical name is3-chloro-4,7-difluoro-N-(4-(methylamino)cyclohexyl)-N-(3-(pyridin-4-yl)benzyl)benzo[b]thiophene-2-carboxamide.

The region of the hair loss includes, for example, but not limited to,scalp, eyebrow, and scar. The hair loss may occur due to variousreasons, including, for example, but not limited to, androgeneticalopecia (AGA) and skin injury. In one embodiment, the AGA is a malepattern baldness. In another embodiment, the AGA is a female patternbaldness. In some embodiments, the AGA is in the scalp or eyebrow.

The step of disrupting can be performed by any suitable method known toone of skilled in the art. In one embodiment, the step of disrupting canbe performed by exposing the region of the hair loss to a suitablemechanical stimulus, known to one of skilled in the art. In anotherembodiment, the step of disrupting can be performed by exposing theregion of the hair loss to a suitable chemical stimulus, known to one ofskilled in the art. In yet another embodiment, the step of disruptingcan be performed by exposing the region of the hair loss to a suitableradiation, known to one of skilled in the art.

In another embodiment, the present invention provides a method fortreating an androgenetic alopecia (AGA) in a scalp of a subjectcomprising the steps of (a) disrupting the epidermis in the region ofsaid hair loss in said subject and (b) administering a compositioncomprising a compound or factor that upregulates sonic hedgehog (SHH) tosaid subject.

In another embodiment, the present invention provides a method forgenerating a hair follicle in the dermis of a subject with hair losscomprising the steps of (a) disrupting the epidermis in the region ofsaid hair loss in said subject and (b) administering a compositioncomprising a fibroblast growth factor-9 polypeptide to said subject.

In another embodiment, the present invention provides a method forgenerating a hair follicle in the dermis of a subject comprising thestep of administering a composition comprising a fibroblast growthfactor-9 polypeptide and a wnt polypeptide to said subject.

In another embodiment, the present invention provides a method forgenerating a hair follicle in the dermis of a subject comprising thesteps of (a) disrupting the epidermis in the region of said hair loss insaid subject and (b) administering a composition comprising a compoundor factor that upregulates sonic hedgehog (SHH) to said subject.

In another embodiment, the present invention provides a method forincreasing the size of a hair follicle in the dermis of a subject withhair loss comprising the steps of (a) disrupting the epidermis in theregion of said hair loss in said subject and (b) administering acomposition comprising a fibroblast growth factor-9 polypeptide to saidsubject.

In another embodiment, the present invention provides a method forincreasing the size of a hair follicle in the dermis of a subjectcomprising the step of administering a composition comprising afibroblast growth factor-9 polypeptide and a wnt polypeptide to saidsubject.

In another embodiment, the present invention provides a method forincreasing the size of a hair follicle in the dermis of a subjectcomprising the steps of (a) disrupting the epidermis in the region ofsaid hair loss in said subject and (b) administering a compositioncomprising a compound or factor that upregulates sonic hedgehog (SHH) tosaid subject.

In another embodiment, the present invention provides a method forincreasing hair follicle formation in the skin of a subject with hairloss comprising the steps of (a) disrupting the epidermis in the regionof said hair loss in said subject and (b) administering a compositioncomprising a fibroblast growth factor-9 polypeptide to said subject.

In another embodiment, the present invention provides a method forincreasing hair follicle formation in the skin of a subject comprisingthe step of administering a composition comprising a fibroblast growthfactor-9 polypeptide and a wnt polypeptide to said subject.

In another embodiment, the present invention provides a method forincreasing hair follicle formation in the skin of a subject comprisingthe steps of (a) disrupting the epidermis in the region of said hairloss in said subject and (b) administering a composition comprising acompound or factor that upregulates sonic hedgehog (SHH) to saidsubject.

In another embodiment, the present invention provides a method fortreating, inhibiting, or suppressing a degenerative skin disordercomprising the steps of (a) disrupting the epidermis in the region ofsaid degenerative skin disorder in said subject and (b) administering acomposition comprising a fibroblast growth factor-9 polypeptide to saidsubject.

In another embodiment, the present invention provides a method fortreating, inhibiting, or suppressing a degenerative skin disordercomprising the step of administering a composition comprising afibroblast growth factor-9 polypeptide and a wnt polypeptide to saidsubject.

In another embodiment, the present invention provides a method fortreating, inhibiting, or suppressing a degenerative skin disordercomprising the steps of (a) disrupting the epidermis in the region ofsaid hair loss in said subject and (b) administering a compositioncomprising a compound or factor that upregulates sonic hedgehog (SHH) tosaid subject.

In one embodiment, the methods of the present invention treat, inhibitor suppress a degenerative skin disorder. In one embodiment, adegenerative skin disorder is Hyperkeratosis, hyperpigmentation,depigmentation, atrophy, or a combination thereof. In one embodiment, adegenerative skin disorder is calcinosis; circumscripta; cutis; Colloidmilium; skin degeneration; Senile dermatosis NOS; or Subcutaneouscalcification.

In another embodiment, a degenerative skin disorder is granulomaannulare. In one embodiment, the degenerative skin disorder is localizedgranuloma annulare, which in one embodiment, is the most common form ofgranuloma annulare and in another embodiment, is characterized by thepresence of small, firm red or yellow colored bumps (nodules or papules)that appear arranged in a ring on the skin. In one embodiment, the sizesof the lesions range from one to five centimeters. In one embodiment,the most commonly affected sites include the feet, hands, and fingers.In other embodiments, the degenerative skin disorder is generalized ordisseminated, linear, perforating, or subcutaneous granuloma annulare.In one embodiment, the lesions associated with granuloma annulare maydisappear without treatment (spontaneous remission) and reappear.

In another embodiment, the methods of the present invention are suitablefor the prophylaxis and treatment of dryness, roughness of the skin, theformation of dry lines, reduced rehydration by sebaceous glands and anincreased susceptibility to mechanical stress (tendency to crack), forthe treatment of photodermatoses, the symptoms of senile xerosis,photoaging and other degenerative conditions which are associated with adecomposition of the connective tissue (collagen and elastin fibres andalso glucosaminoglycans/hyaluronane) of the skin. “Photoaging” denotesthe wrinkling, dryness and decreasing elasticity of the skin broughtabout by light and in particular UV radiation.

Further fields of application of the compositions according to theinvention are the treatment and prevention of age- and/or UV-inducedcollagen degeneration and also the decomposition of elastin andglycosaminoglycans; of degenerative skin conditions such as loss ofelasticity and also atrophy of the epidermal and dermal cell layers, ofconstituents of the connective tissue, of rete pegs and capillaryvessels) and/or the skin adnexa; of environmentally-triggered negativechanges in the skin and the skin adnexa, e.g. caused by ultravioletradiation, smoking, smog, reactive oxygen species, free radicals andsimilar; of deficitary, sensitive or hypoactive skin conditions ordeficitary, sensitive or hypoactive skin adnexa conditions; thereduction in skin thickness; of skin slackness and/or skin tiredness; ofchanges in the transepidermal water loss and normal moisture content ofthe skin; of a change in the energy metabolism of healthy skin; ofdeviations from the normal cell-cell communication in the skin which canmanifest themselves e.g. in wrinkling; of changes in the normalfibroblast and keratinocyte proliferation; of changes in the normalfibroblast and keratinocyte differentiation; of polymorphicactinodermatosis, vitiligo; of wound healing disorders; disturbances tothe normal collagen, hyaluronic acid, elastin and glycosaminoglycanhomeostasis; of increased activation of proteolytic enzymes in the skin,such as e.g. metalloproteinases.

In another embodiment, the present invention provides a method oftreating hair loss, generating a hair follicle, in creasing the size ofa hair follicle, increasing hair follicle formation, treating,inhibiting or suppressing a degenerative skin disorder, treatingandrogenetic alopecia (AGA), comprising any combination of the followingsteps: (a) disrupting the epidermis in the region of said hair loss insaid subject; (b) administering a fibroblast growth factor-9polypeptide; (c) administering a wnt polypeptide; and (d) administeringa compound or factor that upregulates Sonic Hedgehog (SHH), Patched-1(Ptch1), Patched-2 (Ptch2), Gli1, Gli2, or a combination thereof to saidsubject.

In another embodiment, the present invention provides a method ofdepilation comprising the step of administering a composition comprisinga neutralizing fibroblast growth factor-9 antibody to a subject. In oneembodiment, the antibody is administered at a concentration of 10 μg/mL.In one embodiment, the depilation is in the legs, arms, underarms, pubicarea, back, face, nose, or ears of said subject. In one embodiment, themethod further comprises the step of disrupting the epidermis in theregion of said depilation prior to said administering step. In oneembodiment, the step of contacting is performed 3-12 days after saidstep of disrupting. In one embodiment, the step of disrupting isperformed by exposing the region of said hair loss to a mechanical,chemical, or optical stimulus. In one embodiment, the optical stimulusis radiation. In one embodiment, the administering step is via topicaladministration. In another embodiment, the administering step is viasubcutaneous administration.

In another embodiment, the present invention provides a method ofreversing alopecia comprising the step of administering a compositioncomprising a fibroblast growth factor-9 polypeptide to a bald or baldingsubject. In another embodiment, the present invention provides a methodof arresting alopecia comprising the step of administering a compositioncomprising a fibroblast growth factor-9 polypeptide to a bald or baldingsubject.

In another embodiment, the present invention provides a method oftreating a wound in a subject comprising the step of administering acomposition comprising a fibroblast growth factor-9 polypeptide to abald or balding subject. In another embodiment, the present inventionprovides a method of treating an injury in a subject comprising the stepof administering a composition comprising a fibroblast growth factor-9polypeptide to a bald or balding subject.

FGF9

In one embodiment, the methods of the present invention comprise thestep of administering a composition comprising a fibroblast growthfactor-9 polypeptide, alone or in composition with one or moreadditional compounds. In one embodiment, FGF9 refers to Fgf-9, FGF-9,Fibroblast growth factor 9, GAF, glia activating factor, Glia-activatingfactor precursor, or HBGF-9. In one embodiment, the FGF9 protein of themethods of the present invention has the sequence:

IFPNGTIQGTRKDHSRFGILEFISIAVGLVSIRGVDSGLYLGMNEKGELYGSEKLTQECVFREQFEENWYNTYSSNLYKHVDTGRRYYVALNKDGTPREGTRTKRHQKFTHFLPRPVDPDKVPELYKDILSQS (GenBank Accession No: BAA03572; SEQ ID No: 1). Inanother embodiment, the FGF9 protein has a sequence as set forth inGenBank Accession No. P31371, BAF83481, NP_002001, CAC17692, EAX08316,AAI03980, AAI03979, AAT74624 or AAH69692. In another embodiment, theFGF9 protein is encoded by a genomic nucleic acid molecule having asequence as set forth in GenBank Accession No. AL139378.15, AY682094.1,or CH471075.1 or encoded by an mRNA molecule having a sequence as setforth in GenBank Accession No. AK290792.1, BC069692.1, BC103978.1,BC103979.1, CR746503.1, or D14838.1. In another embodiment, abiologically active fragment of an FGF9 protein is utilized in a methodof the present invention. In another embodiment, a homolog of an FGF9protein is utilized in a method of the present invention. Eachpossibility represents a separate embodiment of the present invention.

In one embodiment, administration of recombinant human FGF9 increasedlevels of sonic hedgehog (SHH) gene expression (FIG. 14).

Shh

In one embodiment, the methods of the present invention comprise thestep of administering a composition comprising a sonic hedgehog (SHH)polypeptide, alone or in composition with one or more additionalcompounds. In another embodiment, the methods of the present inventioncomprise the step of administering a compound or factor that increasesSHH expression. In one embodiment, SHH refers to TPT; HHG1; HLP3; HPE3;SMMCI; TPTPS; or MCOPCB5. In one embodiment, the SHH protein of themethods of the present invention has the sequence:

MLLLARCLLLVLVSSLLVCSGLACGPGRGFGKRRHPKKLTPLAYKQFIPNVA EKTLGASGRYEGKISRNSERFKELTPNYNPDIIFKDEENTGADRLMTQRCKDKLNALAISVMNQWPGVKLRVTEGWDEDGHHSEESLHYEGRAVDITTSDRDRSKYGMLARLAVEAGFDWVYYESKAHIHCSVKAENSVAAKSGGCFPGSATVHLEQGGTKLVKDLSPGDRVLAADDQGRLLYSDFLTFLDRDDGAKKVFYVIETREPRERLLLTAAHLLFVAPHNDSATGEPEASSGSGPPSGGALGPRALFASRVRPGQRVYVVAERDGDRRLLPAAVHSVTLSEEAAGAYAPLTAQGTILINRVLASCYAVIEEHSWAHRAFAPFRLAHALLAALAPARTDRGGDSGGGDRGGGGGRVALTAPGAADAPGAGATAGIHWYSQLLYQIGTWLLDSEALHPL GMAVKSS(GenBank Accession No: Q15465.1; SEQ ID No: 2). In another embodiment,the SHH protein has a sequence as set forth in GenBank Accession No.BAA34689.1; AAB67604.1; AAS01990.1; AAQ87879.1; EAL23913.1; EAX04543.1;AAA62179.1; or AAI11926.1. In another embodiment, the SHH protein isencoded by a nucleic acid having a sequence as set forth in GenBankAccession No. AB020410.1; AC002484.1; AC078834.5; AY422195.1;CH236954.1; CH471149.1; AY927450.1; L38518.1; or BC111925.1. In anotherembodiment, a biologically active fragment of a SHH protein is utilizedin a method of the present invention. In another embodiment, a homologof a SHH protein is utilized in a method of the present invention. Eachpossibility represents a separate embodiment of the present invention.

In one embodiment, SHH binds to the patched (PTC) receptor, whichfunctions in association with smoothened (SMO), to activate thetranscription of target genes. In the absence of SHH, PTC represses theconstitutive signaling activity of SMO. In another embodiment, SHH alsoregulates the gli oncogene. In another embodiment, SHH is anintercellular signal essential for a variety of patterning events duringdevelopment: signal produced by the notochord that induces ventral cellfate in the neural tube and somites, and the polarizing signal forpatterning of the anterior-posterior axis of the developing limb bud. Inanother embodiment, SHH displays both floor plate- and motorneuron-inducing activity.

In another embodiment, administration of recombinant human FGF9increased levels of Patched homolog 1 (Drosophila), (PTCH1; FIG. 14),which in one embodiment, is a human gene. In one embodiment, Ptch1encodes a member of the patched gene family. In one embodiment, Ptch1 isthe receptor for sonic hedgehog (SHH), which in one embodiment, is asecreted molecule implicated in the formation of embryonic structuresand in tumorigenesis. In one embodiment, Ptch1 functions as a tumorsuppressor. In one embodiment, mutations of Ptch1 have been associatedwith nevoid basal cell carcinoma syndrome, esophageal squamous cellcarcinoma, trichoepitheliomas, transitional cell carcinomas of thebladder, as well as holoprosencephaly. In one embodiment, alternativesplicing of Ptch1 results in multiple transcript variants encodingdifferent isoforms.

PTCH1

In one embodiment, the methods of the present invention comprise thestep of administering a composition comprising a Patched-1 (PTCH1)polypeptide, alone or in composition with one or more additionalcompounds. In another embodiment, the methods of the present inventioncomprise the step of administering a compound or factor that increasesPTCH1 expression. In one embodiment, PTCHlrefers to PTC; BCNS; HPE7;PTC1; PTCH; NBCCS; PTCH11; FLJ26746; or FLJ42602. In one embodiment, thePTCH1 protein of the methods of the present invention has the sequence:

MASAGNAAEPQDRGGGGSGCIGAPGRPAGGGRRRRTGGLRRAAAPDRDYLHRPSYCDAAFALEQISKGKATGRKAPLWLRAKFQRLLFKLGCYIQKNCGKFLVVGLLIFGAFAVGLKAANLETNVEELWVEVGGRVSRELNYTRQKIGEEAMFNPQLMIQTPKEEGANVLTTEALLQHLDSALQASRVHVYMYNRQWKLEHLCYKSGELITETGYMDQIIEYLYPCLIITPLDCFWEGAKLQSGTAYLLGKPPLRWTNFDPLEFLEELKKINYQVDSWEEMLNKAEVGHGYMDRPCLNPADPDCPATAPNKNSTKPLDMALVLNGGCHGLSRKYMHWQEELIVGGTVKNSTGKLVSAHALQTMFQLMTPKQMYEHFKGYEYVSHINWNEDKAAAILEAWQRTYVEVVHQSVAQNSTQKVLSFTTTTLDDILKSFSDVSVIRVASGYLLMLAYACLTMLRWDCSKSQGAVGLAGVLLVALSVAAGLGLCSLIGISFNAATTQVLPFLALGVGVDDVFLLAHAFSETGQNKRIPFEDRTGECLKRTGASVALTSISNVTAFFMAALIPIPALRAFSLQAAVVVVFNFAMVLLIFPAILSMDLYRREDRRLDIFCCFTSPCVSRVIQVEPQAYTDTHDNTRYSPPPPYSSHSFAHETQITMQSTVQLRTEYDPHTHVYYTTAEPRSEISVQPVTVTQDTLSCQSPESTSSTRDLLSQFSDSSLHCLEPPCTKWTLSSFAEKHYAPFLLKPKAKVVVIFLFLGLLGVSLYGTTRVRDGLDLTDIVPRETREYDFIAAQFKYFSFYNMYIVTQKADYPNIQHLLYDLHRSFSNVKYVMLEENKQLPKMWLHYFRDWLQGLQDAFDSDWETGKIMPNNYKNGSDDGVLAYKLLVQTGSRDKPIDISQLTKQRLVDADGIINPSAFYIYLTAWVSNDPVAYAASQANIRPHRPEWVHDKADYMPETRLRIPAAEPIEYAQFPFYLNGLRDTSDFVEAIEKVRTICSNYTSLGLSSYPNGYPFLFWEQYIGLRHWLLLFISVVLACTFLVCAVFLLNPWTAGIIVMVLALMTVELFGMMGLIGIKLSAVPVVILIASVGIGVEFTVHVALAFLTAIGDKNRRAVLALEHMFAPVLDGAVSTLLGVLMLAGSEFDFIVRYFFAVLAILTILGVLNGLVLLPVLLSFFGPYPEVSPANGLNRLPTPSPEPPPSVVRFAMPPGHTHSGSDSSDSEYSSQTTVSGLSEELRHYEAQQGAGGPAHQVIVEATENPVFAHSTVVHPESRHHPPSNPRQQPHLDSGSLPPGRQGQQPRRDPPREGLWPPPYRPRRDAFEISTEGHSGPSNRARWGPRGARSHNPRNPASTAMGSSVPGYCQPITTVTASASVTVAVHPPPVPGPGRNPRGGLCPGYPETDHGLFEDPHVPFHVRCERRDSKVEVIELQDVECEERPRGSSSN (GenBank AccessionNo: Q13635.2; SEQ ID No: 3). In another embodiment, the PTCH1 proteinhas a sequence as set forth in GenBank Accession No. CAH73817.1;CAH73818.1; CAH73819.1; AAR21238.1; AAR21239.1; AAR21240.1; EAW92631.1;EAW92632.1; BAD74184.1; BAD74185.1; BAD74186.1; BAD74187.1; BAD74188.1;BAD92732.1; BAF47711.1; BAE45300.1; BAE45302.1; BAE45304.1; BAF47712.1;BAC85893.1; AAH43542.1; AAC50496.1; AAC50550.1; or AAI52920.1. Inanother embodiment, the PTCH1 protein is encoded by a nucleic acidhaving a sequence as set forth in GenBank Accession No. AL161729.27;AY395758.1; AY395768.1; AY395772.1; CH471174.1; AB189436.1; AB189437.1;AB189438.1; AB189439.1; AB189440.1; AB209495.1; AB212827.1; AB212828.1;AB214500.1; AB233422.1; AB233424.1; AB239329.1; AI358880.1; AI494442.1;AK124593.1; AK130256.1; BC043542.1; BF195352.1; BM974119.1; BX117041.1;CR744004.1; DB093644.1; U43148.1; U59464.1; or BC152919.1. In anotherembodiment, a biologically active fragment of an PTCH1 protein isutilized in a method of the present invention. In another embodiment, ahomolog of an PTCH1 protein is utilized in a method of the presentinvention. Each possibility represents a separate embodiment of thepresent invention.

In another embodiment, administration of recombinant human FGF9increased levels of Patched homolog 2 (Drosophila), (PTCH; FIG. 14)

PTCH2

In one embodiment, the methods of the present invention comprise thestep of administering a composition comprising a Patched-2 (PTCH2)polypeptide, alone or in composition with one or more additionalcompounds. In another embodiment, the methods of the present inventioncomprise the step of administering a compound or factor that increasesPTCH2 expression. In one embodiment, ptch2 encodes a member of thepatched gene family. In one embodiment, the patched protein is thereceptor for sonic hedgehog, a secreted molecule implicated in theformation of embryonic structures and in tumorigenesis. In oneembodiment, ptch2 is mutated in a medulloblastoma and in a basal cellcarcinoma, suggesting that it plays a role in the development of sometumors. Alternative transcript variants have been described, but theirbiological function has not been determined. In one embodiment, thePTCH2 polypeptide for use in the methods of the present invention hasthe sequence:

FDFIVRYFFAALTVLTLLGLLHGLVLLPVLLSILGPPPEVIQMYKESPEILSPPAPQGGGLRVGSLQVNISYWKELLWCQDLRPEEI (GenBank Accession No: Q5JR97; SEQ IDNo: 4). In another embodiment, the PTCH2 protein has a sequence as setforth in GenBank Accession No. CAI23127.1; CAI13000.1; AAR05447.1;EAX07017.1; AAD25953.1; AAC79847.1; AAD17260.1; AAQ88919.1; AAQ89375.1;or AAI52912.1. In another embodiment, the PTCH2 protein is encoded by anucleic acid having a sequence as set forth in GenBank Accession No.AL136380.22; AL592166.16; AY438664.1; CH471059.2; AF087651.1;AF091501.1; AF119569.1; AK307168.1; AY358555.1; AY359016.1; orBC152911.1. In another embodiment, a biologically active fragment of aPTCH2 protein is utilized in a method of the present invention. Inanother embodiment, a homolog of a PTCH2 protein is utilized in a methodof the present invention. Each possibility represents a separateembodiment of the present invention.

GLI1

In one embodiment, the methods of the present invention comprise thestep of administering a composition comprising a glioma-associatedoncogene homolog 1 (zinc finger protein) (GLI1) polypeptide, alone or ina composition with one or more additional compounds. In one embodiment,gli1 encodes a protein which is a member of the Kruppel family of zincfinger proteins. In another embodiment, the methods of the presentinvention comprise the step of administering a compound or factor thatincreases GLI1 expression. In one embodiment, the GLI1 polypeptide foruse in the methods of the present invention has the sequence:

MFNSMTPPPISSYGEPCCLRPLPSQGAPSVGTEGLSGPPFCHQANLMSGPHSYGPARETNSCTEGPLFSSPRSAVKLTKKRALSISPLSDASLDLQTVIRTSPSSLVAFINSRCTSPGGSYGHLSIGTMSPSLGFPAQMNHQKGPSPSFGVQPCGPHDSARGGMIPHPQSRGPFPTCQLKSELDMLVGKCREEPLEGDMSSPNSTGIQDPLLGMLDGREDLEREEKREPESVYETDCRWDGCSQEFDSQEQLVHHINSEHIHGERKEFVCHWGGCSRELRPFKAQYMLVVHMRRHTGEKPHKCTFEGCRKSYSRLENLKTHLRSHTGEKPYMCEHEGCSKAFSNASDRAKHQNRTHSNEKPYVCKLPGCTKRYTDPSSLRKHVKTVHGPDAHVTKRHRGDGPLPRAPSISTVEPKREREGGPIREESRLTVPEGAMKPQPSPGAQSSCSSDHSPAGSAANTDSGVEMTGNAGGSTEDLSSLDEGPCIAGTGLSTLRRLENLRLDQLHQLRPIGTRGLKLPSLSHTGTTVSRRVGPPVSLERRSSSSSSISSAYTVSRRSSLASPFPPGSPPENGASSLPGLMPAQHYLLRARYASARGGGTSPTAASSLDRIGGLPMPPWRSRAEYPGYNPNAGVTRRASDPAQAADRPAPARVQRFKSLGCVHTPPTVAGGGQNFDPYLPTSVYSPQPPSITENAAMDARGLQEEPEVGTSMVGSGLNPYMDFPPTDTLGYGGPEGAAAEPYGARGPGSLPLGPGPPTNYGPNPCPQQASYPDPTQETWGEFPSHSGLYPGPKALGGTYSQCPRLEHYGQVQVKPEQGCPVGSDSTGLAPCLNAHPSEGPPHPQPLFSHYPQPSPPQYLQSGPYTQPPPDYLPSEPRPCLDFDSPTHSTGQLKAQLVCNYVQSQQELLWEGGGREDAPAQEPSYQSPKFLGGSQVSPSRAKAPVNTYGPGFGPNLPNHKSGSYPTPSPCHENFVVGANRASHRAAAPPRLLPPLPTCYGPLKVGGTNPSCGHPEVGRLGGGPALYPPPEGQVCNPLDSLDLDNTQLDFVAILDEPQGLSPPPSHDQRGSSGHTPPPSGPPNMAVGNMSVLLRSLPGETEFLNSSA (GenBankAccession No: P08151; SEQ ID No: 5). In another embodiment, the GLI1protein has a sequence as set forth in GenBank Accession No. AAM13391.1;EAW97013.1; BAG60219.1; AAH13000.1; or CAA30297.1. In anotherembodiment, the GLI1 protein is encoded by a nucleic acid having asequence as set forth in GenBank Accession No. AC022506.38; AF316573.1;CH471054.1; AK297899.1; BC013000.2; or X07384.1. In another embodiment,a biologically active fragment of a GLI1 protein is utilized in a methodof the present invention. In another embodiment, a homolog of a GLI1protein is utilized in a method of the present invention. Eachpossibility represents a separate embodiment of the present invention.

GLI2

In one embodiment, the methods of the present invention comprise thestep of administering a composition comprising a glioma-associatedoncogene homolog 2 (zinc finger protein) (GLI2) polypeptide, alone or ina composition with one or more additional compounds. In anotherembodiment, the methods of the present invention comprise the step ofadministering a compound or factor that increases GLI2 expression. Inone embodiment, GLI2 may be referred to as HPE9; THP1; or THP2. In oneembodiment, gli2 encodes a protein which belongs to the C2H2-type zincfinger protein subclass of the Gli family. Members of this subclass arecharacterized as transcription factors which bind DNA through zincfinger motifs. These motifs contain conserved H—C links. Gli family zincfinger proteins are mediators of Sonic hedgehog (Shh) signaling and theyare implicated as potent oncogenes in the embryonal carcinoma cell. Theprotein encoded by this gene localizes to the cytoplasm and activatespatched Drosophila homolog (PTCH) gene expression. It is also thought toplay a role during embryogenesis. The encoded protein is associated withseveral phenotypes-Greig cephalopolysyndactyly syndrome, Pallister-Hallsyndrome, preaxial polydactyly type IV, postaxial polydactyly types A1and B. In one embodiment, the GLI2 polypeptide for use in the methods ofthe present invention has the sequence:MALTSINATPTQLSSSSNCLSDTNQNKQSSESAVSSTVNPVAIHKRSKVKTEPEGLRPASPLALTQGQVLDTAHVGVPFPSPQEQLADLKEDLDRDDCKQEAEVVIYETNCHWEDCTKEYDTQEQLVHHINNEHIHGEKKEFVCRWQACTREQKPFKAQYMLVVHMRRHTGEKPHKCTFEGCSKAYSRLENLKTHLRSHTGEKPYVCEHEGCNKAFSNASDRAKHQNRTHSNEKPYICKIPGCTKRYTDPSSLRKHVKTVHGPDAHVTKKQRNDVHLRTPLLKENGDSEAGTEPGGPESTEASSTSQAVEDCLHVRAIKTESSGLCQSSPGAQSSCSSEPSPLGSAPNNDSGVEMPGTGPGSLGDLTALDDTPPGADTSALAAPSAGGLQLRKHMTTMHRFEQLKKEKLKSLKDSCSWAGPTPHTRNTKLPPLPGSGSILENFSGSGGGGPAGLLPNPRLSELSASEVTMLSQLQERRDSSTSTVSSAYTVSRRSSGISPYFSSRRSSEASPLGAGRPHNASSADSYDPISTDASRRSSEASQCSGGSGLLNLTPAQQYSLRAKYAAATGGPPPTPLPGLERMSLRTRLALLDAAEGTLPAGCPRPLGPRRGSDGPTYGHGHAGAAPAFPHEAPGGGTRRASDPVRRPDALSLPRVQRFHSTHNVNPGPLPPCADRRGLRLQSHPSTDGGLARGAYSPRPPSISENVAMEAVAAGVDGAGPEADLGLPEDDLVLPDDVVQYIKAHASGALDEGTGQVYPTESTGFSDNPRLPSPGLHGQRRMVAADSNVGPSAPMLGGCQLGFGAPSSLNKNNMPVQWNEVSSGTVDSLASQVKPPPFPQGNLAVVQQKPAFGQYPGYSPQGLQASPGGLDSTQPHLQPRSGAPSQGIPRVNYMQQLRQPVAGSQCPGMTTTMSPHACYGQVHPQLSPSTISGALNQFPQSCSNMPAKPGHLGHPQQTEVAPDPTTMGNRHRELGVPNSALAGVPPPHPVQSYPQQSHHLAASMSQEGYHQVPSLLPARQPGFMEPQTGPMGVATAGFGLVQPRPPLEPSPTGRHRGVRAVQQQLAYARATGHAMAAMPSSQETAEAVPKGAMGNMGSVPPQPPPQDAGGAPDHSMLYYYGQIHMYEQDGGLENLGSCQVMRSQPPQPQACQDSIQPQPLPSPGVNQVSSTVDSQLLEAPQIDFDAIMDDGDHSSLFSGALSPSLLHSLSQNSSRLTTPRNSLTLPSIPAGISNMAVGDMSSMLTSLAEESKFLNMMT (GenBank Accession No: P10070;SEQ ID No: 6). In another embodiment, the GLI2 protein has a sequence asset forth in GenBank Accession No. AAA35898.1; BAA25665.1; BAA25666.1;BAA25667.1; BAA25668.1; BAD92591.1; BAG61875.1; AAS72889.1; AAS72890.1;AAS72891.1; AAI1l411.1; BAA03568.1; BAA03569.1; AAY58315.1; AAY58316.1;AAY58317.1; or AAY87165.1. In another embodiment, the GLI2 protein isencoded by a nucleic acid having a sequence as set forth in GenBankAccession No. AC016764.8; AC017033.5 (60664 . . . 181887); M20672.1;M20673.1; AB007295.1; AB007296.1; AB007297.1; AB007298.1; AB209354.1;AJ707583.1; AK300071.1; AY493737.1; AY493738.1; AY493739.1; BC111410.1;D14827.1; D14828.1; DQ004396.1; DQ004397.1; DQ004398.1; or DQ086814.1.In another embodiment, a biologically active fragment of a GLI2 proteinis utilized in a method of the present invention. In another embodiment,a homolog of a GLI2 protein is utilized in a method of the presentinvention. Each possibility represents a separate embodiment of thepresent invention.

WNT

In one embodiment, the methods of the present invention comprise thestep of administering a composition comprising a Wnt polypeptide. TheWnt polypeptide of methods and compositions of the present inventionhas, in another embodiment, the sequence:MNRKARRCLGHLFLSLGMVYLRIGGFSSVVALGASIICNKIPGLAPRQRAICQSRPDAIIVIGEGSQMGLDECQFQFRNGRWNCSALGERTVFGKELKVGSREAAFTYAIIAAGVAHAITAACTQGNLSDCGCDKEKQGQYHRDEGWKWGGCSADIRYGIGFAKVFVDAREIKQNARTLMNLHNNEAGRKILEENMKLECKCHGVSGSCTTKTCWTTLPQFRELGYVLKDKYNEAVHVEPVRASRNKRPTFLKIKKPLSYRKPMDTDLVYIEKSPNYCEEDPVTGSVGTQGRACNKTAPQASGCDLMCCGRGYNTHQYARVWQCNCKFHWCCYVKCNTC SERTEMYTCK(GenBank Accession No: BC008811; SEQ ID No: 7). In another embodiment,the Wnt polypeptide has a sequence selected from the sequences set forthin GenBank entries NM_004625, D83175, U53476, and NP_004616. In anotherembodiment, the Wnt polypeptide is a Wnt7 protein. In anotherembodiment, the Wnt polypeptide is a Wnt7a polypeptide. In anotherembodiment, the Wnt polypeptide is Wnt1 protein. In another embodiment,the Wnt polypeptide is a Wnt3 polypeptide. In another embodiment, theWnt polypeptide is a Wnt3a polypeptide. In another embodiment, the Wntpolypeptide is a Wnt10 polypeptide. In another embodiment, the Wntpolypeptide is a Wnt10a protein. In another embodiment, the Wntpolypeptide is a Wnt10b polypeptide. In another embodiment, the Wntpolypeptide is encoded by a nucleic acid molecule having a sequence setforth in the one of the above GenBank entries. In another embodiment, abiologically active fragment of a Wnt polypeptide is utilized in amethod of the present invention. In another embodiment, a biologicallyactive fragment of a Wnt7 protein is utilized in a method of the presentinvention. In another embodiment, a biologically active fragment of aWnt polypeptide is utilized in a method of the present invention. Inanother embodiment, a biologically active fragment of a Wnt7apolypeptide is utilized in a method of the present invention. Eachpossibility represents a separate embodiment of the present invention.

In another embodiment, methods of the present invention stimulate one ormore members of the SHH signaling pathway, which in one embodiment isN-Shh (cleavage product), N-Shh-Chol, which in one embodiment, inhibitsPatched-1 and Patched-2, which in one embodiment, inhibit Smoothened,which in one embodiment, stimulates GLI-1, which in one embodiment,stimulates transcription of other genes (in one embodiment, GLI-1, PTC1,HNF3 3) and GLI-2, and GLI-3, which in one embodiment inhibittranscription of other genes. Thus, in one embodiment, FGF9 stimulationand the resulting increase in SHH will relieve the tonic inhibition ofPatched proteins on the Smoothened protein and increase levels of GLI-1,leading to enhancement of gene transcription.

In another embodiment, methods of the present invention stimulate one ormore members of the WNT signaling pathway, which in one embodiment isFrizzled, SFRP, Dishevelled (Dsh), TCF, LRP, APC, 0-catenin, Axin,Dickkopf, GSK3, Naked, Porcupine, or FRAT/GBP.

In another embodiment, the wnt pathway is stimulated before the hedgehogpathway. In another embodiment, the two pathways are stimulated in anoverlapping fashion. In another embodiment, the two pathways arestimulated simultaneously. Each possibility represents a separateembodiment of the present invention.

In another embodiment, homologues and variants of transcripts andproteins of the present invention are administered in methods of thepresent invention. In another embodiment, homologues and variants oftranscripts and proteins of the present invention are targeted inmethods of the present invention. Each possibility represents a separateembodiment of the present invention.

The terms “homology,” “homologous,” etc, when in reference to anyprotein or peptide, refer in one embodiment, to a percentage of aminoacid residues in the candidate sequence that are identical with theresidues of a corresponding native polypeptide, after aligning thesequences and introducing gaps, if necessary, to achieve the maximumpercent homology, and not considering any conservative substitutions aspart of the sequence identity. Methods and computer programs for thealignment are well known in the art.

In another embodiment, the term “homology,” when in reference to anynucleic acid sequence similarly indicates a percentage of nucleotides ina candidate sequence that are identical with the nucleotides of acorresponding native nucleic acid sequence.

In another embodiment, “homology” refers to identity of greater than70%. In another embodiment, “homology” refers to identity of greaterthan 75%. In another embodiment, “homology” refers to identity ofgreater than 80%. In another embodiment, “homology” refers to identityof greater than 82%. In another embodiment, “homology” refers toidentity of greater than 85%. In another embodiment, “homology” refersto identity of greater than 87%. In another embodiment, “homology”refers to identity of greater than 90%. In another embodiment,“homology” refers to identity of greater than 92%. In anotherembodiment, “homology” refers to identity of greater than 95%. Inanother embodiment, “homology” refers to identity of greater than 97%.In another embodiment, “homology” refers to identity of greater than98%. In another embodiment, “homology” refers to identity of greaterthan 99%. In another embodiment, “homology” refers to identity of 100%.

Protein and/or peptide homology for any amino acid sequence listedherein is determined, in one embodiment, by methods well described inthe art, including immunoblot analysis, or via computer algorithmanalysis of amino acid sequences, utilizing any of a number of softwarepackages available, via established methods. Some of these packages mayinclude the FASTA, BLAST, MPsrch or Scanps packages, and may employ theuse of the Smith and Waterman algorithms, and/or global/local or BLOCKSalignments for analysis, for example. Each method of determininghomology represents a separate embodiment of the present invention.

In one embodiment, the term “peptide” includes native peptides (eitherdegradation products, synthetically synthesized peptides or recombinantpeptides) and peptidomimetics (typically, synthetically synthesizedpeptides), such as peptoids and semipeptoids which are peptide analogs,which may have, for example, modifications rendering the peptides morestable while in a body or more capable of penetrating into bacterialcells. Such modifications include, but are not limited to N terminusmodification, C terminus modification, peptide bond modification,including, but not limited to, CH2-NH, CH2-S, CH2-S═O, O═C—NH, CH2-O,CH2-CH2, S═C—NH, CH═CH or CF═CH, backbone modifications, and residuemodification. Methods for preparing peptidomimetic compounds are wellknown in the art and are specified, for example, in Quantitative DrugDesign, C. A. Ramsden Gd., Chapter 17.2, F. Choplin Pergamon Press(1992), which is incorporated by reference as if fully set forth herein.

Peptide bonds (—CO—NH—) within the peptide may be substituted, forexample, by N-methylated bonds (—N(CH3)-CO—), ester bonds(—C(R)H—C—O—O—C(R)—N—), ketomethylen bonds (—CO—CH2-), ca-aza bonds(—NH—N(R)—CO—), wherein R is any alkyl, e.g., methyl, carba bonds(—CH2-NH—), hydroxyethylene bonds (—CH(OH)—CH2-), thioamide bonds(—CS—NH—), olefinic double bonds (—CH═CH—), retro amide bonds (—NH—CO—),peptide derivatives (—N(R)—CH2-CO—), wherein R is the “normal” sidechain, naturally presented on the carbon atom.

These modifications can occur at any of the bonds along the peptidechain and even at several (2-3) at the same time.

Natural aromatic amino acids, Trp, Tyr and Phe, may be substituted forsynthetic non-natural acid such as TIC, naphthylelanine (Nol),ring-methylated derivatives of Phe, halogenated derivatives of Phe oro-methyl-Tyr.

In addition to the above, the peptides of the present invention may alsoinclude one or more modified amino acids or one or more non-amino acidmonomers (e.g. fatty acids, complex carbohydrates etc).

As used herein in the specification and in the claims section below theterm “amino acid” or “amino acids” is understood to include the 20naturally occurring amino acids; those amino acids often modifiedpost-translationally in vivo, including, for example, hydroxyproline,phosphoserine and phosphothreonine; and other unusual amino acidsincluding, but not limited to, 2-aminoadipic acid, hydroxylysine,isodesmosine, nor-valine, nor-leucine and ornithine. Furthermore, theterm “amino acid” includes both D- and L-amino acids.

In another embodiment, naturally occurring amino acids andnon-conventional or modified amino acids as are known in the art can beused with the present invention.

In another embodiment, the present invention provides a kit, comprisinga tools and/or a compound suitable for performing a method of thepresent invention.

In another embodiment, the present invention provides a device,comprising a tool suitable for epidermal disruption and a means ofdelivering a compound or factor that upregulates expression of SHH.

It is to be understood that included in the present invention aremethods comprising the step of administering an isolated nucleic acid,in one embodiment, a vector or plasmid, encoding a polypeptide of thepresent invention, which in one embodiment, is a fibroblast growthfactor-9 polypeptide, shh, wnt, ptch1, ptch, gli1, or gli2, or acomposition comprising such a vector.

In one embodiment, an isolated nucleic acid that encodes a polypeptideof the present invention for use in the methods of the present inventionis provided.

In one embodiment, an “isolated nucleic acid” refers to a nucleic acidsegment or fragment which has been separated from sequences which flankit in a naturally occurring state, e.g., a DNA fragment which has beenremoved from the sequences which are normally adjacent to the fragment,e.g., the sequences adjacent to the fragment in a genome in which itnaturally occurs. The term also applies to nucleic acids which have beensubstantially purified from other components which naturally accompanythe nucleic acid, e.g., RNA or DNA or proteins, which naturallyaccompany it in the cell. The term therefore includes, for example, arecombinant DNA which is incorporated into a vector, into anautonomously replicating plasmid or virus, or into the genomic DNA of aprokaryote or eukaryote, or which exists as a separate molecule (e.g.,as a cDNA or a genomic or cDNA fragment produced by PCR or restrictionenzyme digestion) independent of other sequences. It also includes arecombinant DNA which is part of a hybrid gene encoding additionalpolypeptide sequence.

In one embodiment, the present invention provides a cell comprising anisolated nucleic acid or vector of the present invention.

In one embodiment, two polynucleotides of the present invention areoperably linked. For example, in one embodiment, polynucleotidesencoding FGF9 and WNT may be operably linked. In one embodiment,“operably linked” indicates that a single-stranded or double-strandednucleic acid moiety comprises the two polynucleotides arranged withinthe nucleic acid moiety in such a manner that they are expressedtogether. By way of example, a promoter operably linked to the codingregion of a gene is able to promote transcription of the coding region.

In one embodiment, a polynucleotide of the present invention comprises apromoter/regulatory sequence, which in one embodiment, thepromoter/regulatory is positioned at the 5′ end of the desired proteincoding sequence such that it drives expression of the desired protein ina cell. Together, the nucleic acid encoding the desired protein and itspromoter/regulatory sequence comprise a “transgene.”

In one embodiment, the term “promoter/regulatory sequence” refers to anucleic acid sequence which is required for expression of a gene productoperably linked to the promoter/regulatory sequence. In some instances,this sequence may be the core promoter sequence and in other instances,this sequence may also include an enhancer sequence and other regulatoryelements which are required for expression of the gene product. Thepromoter/regulatory sequence may, for example, be one which expressesthe gene product in a tissue specific manner. In one embodiment, apromoter used in the present invention may be constitutive or inducible.In another embodiment, a promoter for use in the methods of the presentinvention may be tissue-specific. Such promoters are well known in theart.

In another embodiment, the present invention provides a delivery vehiclefor administration of a polypeptide of the present invention. Examplesof such delivery vehicles are known in the art and may includerecombinant viruses or bacteria engineered to express said polypeptide.In one embodiment, said viruses or bacteria are attenuated. In oneembodiment, viruses for use in the methods of the present invention mayinclude retroviruses, adenoviruses, adeno-associated viruses, etc. Inone embodiment, the virus may be of any known serotype or subgroup.

In one embodiment, any one of a number of different vectors can be usedin the methods of the present invention, such as viral vectors, plasmidvectors, linear DNA, etc., as known in the art, to introduce anexogenous nucleic acid fragment encoding a therapeutic agent into targetcells and/or tissue. These vectors can be inserted, for example, usinginfection, transduction, transfection, calcium-phosphate mediatedtransfection, DEAE-dextran mediated transfection, electroporation,liposome-mediated transfection, biolistic gene delivery, liposomal genedelivery using fusogenic and anionic liposomes (which are an alternativeto the use of cationic liposomes), direct injection, receptor-mediateduptake, magnetoporation, ultrasound, or any combination thereof, as wellas other techniques known in the art (for further detail see, forexample, “Methods in Enzymology” Vol. 1-317, Academic Press, CurrentProtocols in Molecular Biology, Ausubel F. M. et al. (eds.) GreenePublishing Associates, (1989) and in Molecular Cloning: A LaboratoryManual, 2nd Edition, Sambrook et al. Cold Spring Harbor LaboratoryPress, (1989), or other standard laboratory manuals). The polynucleotidesegments encoding sequences of interest can be ligated into anexpression vector system suitable for transducing mammalian cells andfor directing the expression of recombinant products within thetransduced cells. The introduction of the exogenous nucleic acidfragment is accomplished by introducing the vector into the vicinity ofthe micro-organ. Once the exogenous nucleic acid fragment has beenincorporated into the cells using any of the techniques described aboveor known in the art, the production and/or the secretion rate of thetherapeutic agent encoded by the nucleic acid fragment can bequantified. In one embodiment, the term “exogenous” refers to asubstance that originated outside, for example a nucleic acid thatoriginated outside of a cell or tissue.

In one embodiment, a vector for use in the methods of the presentinvention is a non-immunogenic gene transfer agent such as a nonviralvector (e.g. DNA plasmids or minicircle DNA), a “gutless” viral vectori.e. without endogenous genes (which in one embodiment, is due to adeletion, while in another embodiment, due to an insertion, substitutionor deletion in a gene that prevents gene expression), a helper-dependentadenovirus (HDAd) vector, or adeno associated virus AAV (which in oneembodiment is single stranded and in another embodiment, doublestranded). In another embodiment, said formulation is so chosen suchthat recombinant gene expression results in lack of toxicity orimmune-mediated rejection of the gene product by the tissue. In oneembodiment, the vector is virally derived, and in another embodiment,the vector is a plasmid. In one embodiment, the virally-derived vectoris derived from adenovirus, which in one embodiment, is helper-dependentadenovirus, while in another embodiment, the virally-derived vector isderived from adenovirus-associated vector.

In one embodiment, the term “vector” or “expression vector” refers to acarrier molecule into which a nucleic acid sequence can be inserted forintroduction into a cell where it can be replicated. In one embodiment,the nucleic acid molecules are transcribed into RNA, which in some casesare then translated into a protein, polypeptide, or peptide. In othercases, RNA sequences are not translated, for example, in the productionof antisense molecules or ribozymes. In one embodiment, expressionvectors can contain a variety of “control sequences” which refer tonucleic acid sequences necessary for the transcription and possiblytranslation of an operably linked coding sequence in a particular hostcell. In another embodiment, a vector further includes an origin ofreplication. In one embodiment the vector may be a shuttle vector, whichin one embodiment can propagate both in prokaryotic and eukaryoticcells, or in another embodiment, the vector may be constructed tofacilitate its integration within the genome of an organism of choice.The vector, in other embodiments may be, for example, a plasmid, abacmid, a phagemid, a cosmid, a phage, a virus or an artificialchromosome. In one embodiment, the vector is a viral vector, which inone embodiment may be a bacteriophage, mammalian virus, or plant virus.

In other embodiments, the viral vector is derived from a virus such asvaccinia virus, lentivirus, polio virus, hepatitis virus, papillomavirus, cytomegalovirus, simian virus, or herpes simplex virus.

In certain embodiments of the invention, the vector comprising a nucleicacid sequence may comprise naked recombinant DNA or plasmids. Transferof the construct may be performed by any method which physically orchemically permeabilizes the cell membrane. In one embodiment, thevector is a mini-circle DNA, which in one embodiment, is a supercoiledDNA molecule for non-viral gene transfer, which has neither a bacterialorigin of replication nor an antibiotic resistance marker.

Construction of vectors using standard recombinant techniques is wellknown in the art (see, for example, Maniatis, et al., Molecular Cloning,A Laboratory Manual (Cold Spring Harbor, 1990) and Ausubel, et al.,1994, Current Protocols in Molecular Biology (John Wiley & Sons, 1996),both incorporated herein by reference).

In one embodiment, compositions of the present invention comprise theindicated agent, while in another embodiment, compositions of thepresent invention consist essentially of the indicated agent, while inanother embodiment, compositions of the present invention consist of theindicated agent. In some embodiments, the term “comprise” refers to theinclusion of the indicated active agent, such as human fibroblast growthfactor-9 polypeptide, shh, wnt, etc, as well as inclusion of otheractive agents, and pharmaceutically acceptable carriers, excipients,emollients, stabilizers, etc., as are known in the pharmaceuticalindustry. In some embodiments, the term “consisting essentially of”refers to a composition, whose only active ingredient is the indicatedactive ingredient, however, other compounds may be included which arefor stabilizing, preserving, etc. the formulation, but are not involveddirectly in the therapeutic effect of the indicated active ingredient.In some embodiments, the term “consisting essentially of” may refer tocomponents which facilitate the release of the active ingredient. Insome embodiments, the term “consisting” refers to a composition, whichcontains the active ingredient and a pharmaceutically acceptable carrieror excipient.

In one embodiment, methods of the present invention treat, inhibit orsuppress hair loss. In one embodiment, methods of the present inventiongenerate hair follicles or increase hair follicle size, in oneembodiment, in a subject with hair loss. In one embodiment, hair loss isdue to androgenetic alopecia (AGA). In another embodiment, hair loss isdue to male pattern baldness. In another embodiment, hair loss is due tofemale pattern baldness. In another embodiment, hair loss is the resultof a skin injury.

In another embodiment, the methods of the present invention treat,inhibit, or suppress a disease or disorder in a subject. In oneembodiment, the subject has a disease or disorder comprising balding. Inanother embodiment, the subject does not have a disease or disordercomprising balding. In another embodiment, the disease or disorder isandrogenetic alopecia (AGA). In another embodiment, the disease ordisorder is male pattern baldness. In another embodiment, the disease ordisorder is female pattern baldness. In another embodiment, the diseaseor disorder is a discoid lupus erythematosis. In another embodiment, thedisease or disorder is a congenital hypotrichosis. In anotherembodiment, the disease or disorder is a lichen planopilaris.

In another embodiment, the disease or disorder is a scarring (or, inanother embodiment, cicatricial) alopecia, which in one embodiment, ishair loss due to scarring of the scalp area. In one embodiment, scarringalopecia typically involves the top of the scalp and occurspredominantly in women. The condition frequently occurs inAfrican-American women and is believed to be associated with persistenttight braiding or “corn-rowing” of scalp hair. A form of scarringalopecia also may occur in post-menopausal women, associated withinflammation of hair follicles and subsequent scarring. In anotherembodiment, the disease or disorder is any other disease or disordercomprising balding known in the art.

In another embodiment, the present invention provides methods fortreating Alopecia areata, which in one embodiment, is an autoimmunedisorder that causes patchy hair loss that can range from diffusethinning to extensive areas of baldness with “islands” of retained hair.

In another embodiment, the present invention provides methods fortreating Trichotillomania, which in one embodiment, compulsive hairpulling. Hair loss due to trichotillomania is typically patchy, ascompulsive hair pullers tend to concentrate the pulling in selectedareas.

In another embodiment, the present invention provides methods fortreating Triangular alopecia, which in one embodiment, is a loss of hairin the temporal areas that sometimes begins in childhood. Hair loss maybe complete, or a few fine, thin-diameter hairs may remain.

In another embodiment, the present invention provides methods fortreating Telogen effluvium, which in one embodiment, is a common type ofhair loss caused when a large percentage of scalp hairs are shifted into“shedding” phase. The causes of telogen effluvium may be hormonal,nutritional, drug-associated, or stress-associated.

In another embodiment, the present invention provides methods fortreating Loose-anagen syndrome, which in one embodiment, is a conditionoccurring primarily in fair-haired persons in which scalp hair sitsloosely in hair follicles and is easily extracted by combing or pulling.In one embodiment, the condition may appear in childhood.

In another embodiment, the present invention provides methods fortreating Tinea Capitis (Scalp Ringworm), which in one embodiment, iscaused by a fungal infection, and in one embodiment, is characterized bypatches of scaling that can spread and result in broken hair, redness,swelling, and oozing on the scalp.

In another embodiment, the present invention provides methods fortreating hair loss associated with particular conditions, which in oneembodiment, is cancer, thyroid disease, inadequate protein in diet, lowserum iron levels, or associated with particular environmental stimuli,which in one embodiment, is chemotherapy, or, in another embodiment,radiotherapy.

In other embodiments, the present invention provides a method oftreating any disease, disorder, or symptom associated with balding. Inother embodiments, the present invention provides a method of treatingany disease, disorder, or symptom associated with degenerative skindisorder. In other embodiments, the present invention provides a methodof treating any disease, disorder, or symptom associated with alopecia.Each disease, disorder, or symptom represents a separate embodiment ofthe present invention.

In one embodiment, “treating” refers to either therapeutic treatment orprophylactic or preventative measures, wherein the object is to preventor lessen the targeted pathologic condition or disorder as describedhereinabove. Thus, in one embodiment, treating may include directlyaffecting or curing, suppressing, inhibiting, preventing, reducing theseverity of, delaying the onset of, reducing symptoms associated withthe disease, disorder or condition, or a combination thereof. Thus, inone embodiment, “treating” refers inter alia to delaying progression,expediting remission, inducing remission, augmenting remission, speedingrecovery, increasing efficacy of or decreasing resistance to alternativetherapeutics, or a combination thereof. In one embodiment, “preventing”refers, inter alia, to delaying the onset of symptoms, preventingrelapse, decreasing the number or frequency of relapse episodes,increasing latency between symptomatic episodes, or a combinationthereof. In one embodiment, “suppressing” or “inhibiting”, refers interalia to reducing the severity of symptoms, reducing the severity of thecurrent episode, reducing the number of symptoms, reducing the incidenceof symptoms, reducing the latency of symptoms, ameliorating symptoms,reducing secondary symptoms, reducing secondary infections, or acombination thereof.

In one embodiment, symptoms are primary, while in another embodiment,symptoms are secondary. In one embodiment, “primary” refers to a symptomthat is a direct result of the alopecia, while in one embodiment,“secondary” refers to a symptom that is derived from or consequent to aprimary cause. In one embodiment, the compositions and strains for usein the present invention treat primary or secondary symptoms orsecondary complications related to alopecia, in one embodiment,seborrheic dermatitis.

In another embodiment, “symptoms” may be any manifestation of alopecia,comprising hair loss, balding, temporary hair loss, patchy hair loss,degenerative skin disorders or a combination thereof.

Methods of determining the presence and severity of alopecia and/ordegenerative skin disorders such as those described herein are wellknown in the art. Each method represents a separate embodiment of thepresent invention.

In one embodiment, the methods of the present invention are for treatinga subject with hair loss. In one embodiment, the hair loss is in thescalp of the subject. In another embodiment, the hair loss is in theeyebrow of the subject. In another embodiment, the hair loss is inscarred skin tissue of the subject, which in one embodiment, may bescalp, eyebrow, arm, or leg of a subject. In another embodiment, anyother hair-bearing area or region of the skin is treated by a method ofthe present invention. Each possibility represents a separate embodimentof the present invention.

In one embodiment, methods of the present invention comprise the step ofdisrupting the epidermis in the region of said hair loss prior to saidadministering step. In another embodiment, the epithelium is disrupted.

In another embodiment of methods and compositions of the presentinvention, the first step (e.g. epidermal disruption) is performed 3-12days prior to the second step (e.g. addition of an active compound,factor, cell, etc). In another embodiment, the interval is 4-12 days. Inanother embodiment, the interval is 5-12 days. In another embodiment,the interval is 4-11 days. In another embodiment, the interval is 6-11days. In another embodiment, the interval is 6-10 days. In anotherembodiment, the interval is 6-9 days. In another embodiment, theinterval is 6-8 days. In another embodiment, the interval is 7-8 days.In another embodiment, the interval is 5-11 days. In another embodiment,the interval is 5-10 days. In another embodiment, the interval is 7-10days. In another embodiment, the interval is about 1 week. In anotherembodiment, the compositions for use in the methods of the presentinvention are applied as the scabbing starts to heal, which in oneembodiment is 3-12 days after epidermal disruption. In one embodiment,the compositions for use in the methods of the present invention areapplied one day after scab detachment, in another embodiment, two daysafter scab detachment, in another embodiment, three days after scabdetachment, in another embodiment, four days after scab detachment, inanother embodiment, five days after scab detachment, in anotherembodiment, six days after scab detachment, in another embodiment, sevendays or more after scab detachment. In another embodiment, thecompositions for use in the present invention are administered on days1-4 after scab detachment. Each possibility represents a separateembodiment of the present invention.

In one embodiment, the step of disrupting is performed by exposing theregion of said hair loss to a mechanical, chemical, or optical stimulus.In one embodiment, the optical stimulus is radiation.

The step of disrupting the epidermis in methods of the present inventionis performed, in another embodiment, by abrading the skin region ofinterest. In another embodiment, the term “abrading” refers to an act ofcreating an abrasion. In another embodiment, “abrading” refers torubbing. In another embodiment, “abrading” refers to wearing away byfriction. In one embodiment, epidermal abrasion causes, under theconditions utilized herein, de novo HF neo-genesis. In anotherembodiment, the epidermal layer is disrupted.

In one embodiment, “abrasion” refers to a wound consisting ofsuperficial damage to the skin. In another embodiment, “abrasion” refersto an area of the scalp or skin from which the epidermis is removed. Inanother embodiment, “abrasion” refers to an area of the scalp or skinfrom which the epidermis and dermis are removed. Each definition of“abrading” and “abrasion” represents a separate embodiment of thepresent invention.

In one embodiment, epidermal disruption by a method of the presentinvention converts the skin region of interest back to an embryonic-likestate, in which the follicle regenerates. In another embodiment, asubsequent window of opportunity is created, during which the number andsize of new HF in the skin region of interest can be manipulated. Inanother embodiment, the administration of a compound or factor thatpromotes a differentiation of an uncommitted epidermal cell into a HFcell during this window causes regeneration of larger and more numerousHF. In one embodiment, the morphology of HF in abraded skin is similarto that of embryonic HF, and the markers expressed are similar as well.

In another embodiment, the excisional wounds of methods of the presentinvention are created using a surgical tool. In one embodiment, thesurgical tool is a dermal biopsy punch. In another embodiment, theexcisional wounds are induced by freezing or cryoinjury. The use offreezing or cryoinjury is well known in the art, and is used, forexample by dermatologists to injure skin. In one embodiment, thefreezing or cryoinjury results in a blister. In another embodiment, theblister is used as a “chamber” to introduce drugs and or cells into thereepithelialized area. Each possibility represents a separate embodimentof the present invention.

In another embodiment, the epidermal disruption in methods of thepresent invention further removes dermal tissue from the skin region ofinterest. In another embodiment, the epidermal disruption does notremove dermal tissue from the skin region of interest. Each possibilityrepresents a separate embodiment of the present invention.

“Disrupting” an epidermis or epidermal layer refers, in anotherembodiment, to removing part of the epidermis or epidermal layer. Inanother embodiment, the term refers to disturbing the intactness of theepidermis or epidermal layer. In another embodiment, the term refers toperforating the epidermis or epidermal layer. In another embodiment,only part of the epidermal layer need be removed. In another embodiment,the entire epidermal layer is removed. In another embodiment, the termrefers to abrading the epidermis or epidermal layer. In anotherembodiment, the term refers to wounding the epidermis or epidermallayer. Each possibility represents a separate embodiment of the presentinvention.

In another embodiment, the epidermal disruption is performed with a toolthat comprises sandpaper. In another embodiment, the epidermaldisruption is performed with a laser. In another embodiment, the laseris a Fraxel laser. In another embodiment, the laser is a CO₂ laser. Inanother embodiment, the laser is an excimer laser. In anotherembodiment, the laser is any other type of laser capable of inducingtrans-epithelial injury. In another embodiment, the epidermal disruptionis performed with a felt wheel. In another embodiment, the epidermaldisruption is performed with a surgical tool. In another embodiment, theepidermal disruption is performed with any other tool known in the artthat is capable of epidermal disruption. In another embodiment, theepidermal disruption comprises use of a micro-dermabrasion device. Inanother embodiment, the epidermal disruption comprises a burn treatment.

In another embodiment, the epidermal disruption comprises a disruptionof a follicle of said epidermis and a disruption of an interfollicularregion of said epidermis. In another embodiment, the epidermaldisruption comprises a disruption of a follicle of said epidermis anddoes not comprise a disruption of an interfollicular region of saidepidermis. Each possibility represents a separate embodiment of thepresent invention.

In another embodiment, the epidermal disruption comprises a light-basedmethod. In another embodiment, the epidermal disruption comprisesirradiation with visible light. In another embodiment, the epidermaldisruption comprises irradiation with infrared light. In anotherembodiment, the epidermal disruption comprises irradiation withultraviolet radiation. In another embodiment, the epidermal disruptioncomprises orthovoltage irradiation. In another embodiment, the epidermaldisruption comprises X-ray irradiation. In another embodiment, theepidermal disruption comprises any other type of irradiation known inthe art.

In another embodiment, the epidermal disruption is performed bymechanical means. In another embodiment, “mechanical means” refers toabrading. In another embodiment, the term refers to wounding. In anotherembodiment, the term refers to ultrasound. In another embodiment, theterm refers to radio-frequency. In another embodiment, the term refersto an electrical process or the use of an electrical current. In anotherembodiment, the term refers to electoporation. In another embodiment,the term refers to excision. In another embodiment, the term refers totape-stripping. In another embodiment, the term refers tomicrodermabrasion. In another embodiment, the term refers to the use ofpeels. In another embodiment, the term refers to any other type ofmechanical means known in the art. Each possibility represents aseparate embodiment of the present invention.

In another embodiment, the epidermal disruption comprises chemicaltreatment. In another embodiment, the chemical is phenol. In anotherembodiment, the chemical is trichloracetic acid. In another embodiment,the chemical is ascorbic acid. In another embodiment, the chemical isany other chemical capable of epidermal disruption that is known in theart.

In another embodiment, epidermal trauma is utilized in a method of thepresent invention.

Each method or type of epidermal disruption, abrasion, and traumarepresents a separate embodiment of the present invention.

In one embodiment, “WIHN” refers to HF neogenesis induced by disruptionof the epithelial layer. In another embodiment, the term refers to HFneogenesis induced by abrasion. In another embodiment, the term refersto HF neogenesis induced by wounding. In another embodiment, the termrefers to HF neogenesis induced by disruption of the epithelial layer,followed by administration of a compound or factor that promotes adifferentiation of an uncommitted epidermal cell into a HF cell. Eachpossibility represents a separate embodiment of the present invention.

In another embodiment, the epidermal disruption of methods of thepresent invention creates an abrasion at least about 1-1.5 centimeters(cm) in width. In another embodiment, the abrasion is at least about 1cm in width. In another embodiment, the abrasion is at least about 1.5cm in width. In another embodiment, the abrasion is at least about 2 cmin width. Each type of abrasion represents a separate embodiment of thepresent invention.

In another embodiment, the excisional wounds of methods of the presentinvention are not surgically closed. In another embodiment, theexcisional wounds are allowed to heal by secondary intention. In anotherembodiment, the skin region of interest is not contacted with a bandageor dressing following the epidermal disruption. In another embodiment,the skin region of interest is not contacted with an ointment followingthe epidermal disruption. In another embodiment, the skin region ofinterest is allowed to heal for a period of time without being contactedby any substance, device, ointment, etc., that is ordinarilyadministered to an abrasion or wound to facilitate healing. In anotherembodiment, the skin region of interest is allowed to heal for a periodof time without being contacted by any substance, device, ointment,etc., that is ordinarily administered to an abrasion or wound to preventinfection. In another embodiment, the “period of time” is the time ittakes the epidermal disruption to heal. In another embodiment, theperiod of time is any time or range of times between 2 days and 3 weeks.Each possibility represents a separate embodiment of the presentinvention.

In one embodiment, “following” refers to a period of time of about 2days. In another embodiment, “following” refers to a period of time ofabout 3 days. In another embodiment, “following” refers to a period oftime of about 4 days. In another embodiment, “following” refers to aperiod of time of about 5 days. In another embodiment, “following”refers to a period of time of about 7 days. In another embodiment,“following” refers to a period of time of about 10 days. In anotherembodiment, “following” refers to a period of time of about 2 weeks. Inanother embodiment, “following” refers to a period of time of about 3weeks. Each possibility represents a separate embodiment of the presentinvention.

In another embodiment, a method of the present invention furthercomprises the step of depilating the skin in the region in which hairgrowth or follicle formation is desired. In one embodiment, said step ofdepilating is performed prior to said step of epidermal disruption.

In another embodiment, the depilation is epilation. In anotherembodiment, the depilation comprises the step of waxing. In anotherembodiment, the depilation comprises the step of plucking. In anotherembodiment, the depilation comprises the use of an abrasive material. Inanother embodiment, the depilation comprises the use of a laser. Inanother embodiment, the depilation comprises the use of electrolysis. Inanother embodiment, the depilation comprises the use of a mechanicaldevice. In another embodiment, the depilation comprises the use ofthioglycolic acid. In another embodiment, the depilation comprises theuse of any other method of depilation or epilation known in the art.Each possibility represents a separate embodiment of the presentinvention.

In another embodiment, the additional step (depilation or administrationof a retinoid) is performed prior to the step of disrupting theepidermis. In another embodiment, the additional step is performedfollowing the step of disrupting the epidermis, but prior to theaddition of the compound or factor that of the present invention. Inanother embodiment, the additional step is performed concurrently withthe addition of the differentiation-promoting compound or factor. Inanother embodiment, the additional step is performed following theaddition of the differentiation-promoting compound or factor. Eachpossibility represents a separate embodiment of the present invention.

In another embodiment, a method of the present invention furthercomprises the step of administering a topical retinoid to the skinregion of interest. In one embodiment, the topical retinoid inducesresting (telogen) HF in the skin region of interest to enter anagen.Each possibility represents a separate embodiment of the presentinvention.

In another embodiment, the additional step is performed between abouttwo days and about three weeks before the step of abrading. In anotherembodiment, the additional step is performed about two days before thestep of abrading. In another embodiment, the additional step isperformed about three days before the step of abrading. In anotherembodiment, the additional step is performed about four days before thestep of abrading. In another embodiment, the additional step isperformed about one week before the step of abrading. In anotherembodiment, the additional step is performed about ten days before thestep of abrading. In another embodiment, the additional step isperformed about two weeks before the step of abrading. In anotherembodiment, the additional step is performed about three weeks beforethe step of abrading. Each possibility represents a separate embodimentof the present invention.

In one embodiment, the methods of the present invention further comprisethe step of administering an antagonist of an androgen or an antagonistof an androgen receptor. In another embodiment, the methods of thepresent invention further comprise the step of administering a 5alpha-reductase type 2 inhibitor.

In another embodiment, a method of the present invention furthercomprises the step of contacting the skin region of interest with ananti-androgen compound. In one embodiment, the anti-androgen compound isfinasteride. In another embodiment, the anti-androgen compound isFluridil®. In another embodiment, the anti-androgen compound isdutasteride. In another embodiment, the anti-androgen compound isspironolactone. In another embodiment, the anti-androgen compound iscyproterone acetate. In another embodiment, the anti-androgen compoundis bicalutamide. In another embodiment, the anti-androgen compound isflutamide. In another embodiment, the anti-androgen compound isnilutamide. In another embodiment, the anti-androgen compound is aninhibitor of an androgen receptor. In another embodiment, theanti-androgen compound is any other anti-androgen compound known in theart. Each possibility represents a separate embodiment of the presentinvention.

In another embodiment, a method of the present invention furthercomprises the step of contacting the skin region of interest with anestrogen compound. In another embodiment, a method of the presentinvention further comprises the step of contacting the skin region ofinterest with an estrogen receptor agonist. In another embodiment, amethod of the present invention further comprises the step of contactingthe skin region of interest with an estrogen analogue. In oneembodiment, the estrogen analogue is estradiol. In another embodiment,the estrogen analogue is 17 beta-estradiol. In another embodiment, theestrogen analogue is 17 alpha-estradiol. In another embodiment, theestrogen analogue is ZYC3. In another embodiment, the estrogen compound,estrogen receptor agonist, or estrogen analogue is any other estrogencompound, estrogen receptor agonist, or estrogen analogue known in theart. Each possibility represents a separate embodiment of the presentinvention.

In another embodiment, a method of the present invention furthercomprises the step of contacting the skin region of interest with aninhibitor of an EGF protein. In another embodiment, a method of thepresent invention further comprises the step of contacting the skinregion of interest with an inhibitor of an EGFR. In another embodiment,a method of the present invention further comprises the step ofcontacting the skin region of interest with a compound that reduces anexpression of an EGF protein or an EGFR. Each possibility represents aseparate embodiment of the present invention.

In another embodiment, the inhibitor of an EGF or an EGF receptor ispanitumumab. In another embodiment, the inhibitor is AG1478. In anotherembodiment, the inhibitor is nimotuzumab. In another embodiment, theinhibitor is an antibody that binds EGF or EGFR. In another embodiment,the inhibitor is HuMax-EGFR® (Genmab, Copenhagen, Denmark). In anotherembodiment, the inhibitor is cetuximab. In another embodiment, theinhibitor is IMC 11F8. In another embodiment, the inhibitor ismatuzumab. In another embodiment, the inhibitor is SC 100. In anotherembodiment, the inhibitor is ALT 110. In another embodiment, theinhibitor is PX 1032. In another embodiment, the inhibitor is BMS599626. In another embodiment, the inhibitor is MDX 214. In anotherembodiment, the inhibitor is PX 1041. In another embodiment, theinhibitor is any other inhibitor of an EGF or an EGF receptor known inthe art. Each possibility represents a separate embodiment of thepresent invention.

In another embodiment, a method of the present invention furthercomprises the step of contacting the skin region of interest with aninhibitor of a tyrosine kinase activity of an EGF receptor. In anotherembodiment, the inhibitor is gefitinib. In another embodiment, theinhibitor is erlotinib. In another embodiment, the inhibitor iscanertinib. In another embodiment, the inhibitor is leflunomide. Inanother embodiment, the inhibitor is A77 1726. In another embodiment,the inhibitor is pelitinib. In another embodiment, the inhibitor is ZD1839. In another embodiment, the inhibitor is CL 387785. In anotherembodiment, the inhibitor is EKI 785. In another embodiment, theinhibitor is vandetanib. In another embodiment, the inhibitor is anyother inhibitor of a tyrosine kinase activity of an EGF receptor knownin the art. Each possibility represents a separate embodiment of thepresent invention.

In another embodiment, a method of the present invention furthercomprises the step of contacting the skin region of interest with an EGFor EGFR antagonist. In another embodiment, the EGF or EGFR antagonist isa carboxypeptidase inhibitor from potato (PCI) protein or a homologue,fragment or mimetic thereof. In another embodiment, the EGF or EGFRantagonist is a sprouty protein or a homologue, fragment or mimeticthereof. In another embodiment, the EGF or EGFR antagonist is an Argosprotein or a homologue, fragment or mimetic thereof. In anotherembodiment, the EGF or EGFR antagonist is a lefty protein or ahomologue, fragment or mimetic thereof. In another embodiment, the EGFor EGFR antagonist is an antibody that recognizes EGF or EGFR, or afragment or mimetic thereof. In another embodiment, the EGF or EGFRantagonist is small molecule inhibitor that binds and reduces theactivity of EGF or EGFR. In another embodiment, the EGF or EGFRantagonist is CRM197. In another embodiment, the EGF or EGFR antagonistis IMC-C225 (ImClone Systems, New York, N.Y.). In another embodiment,the EGF or EGFR antagonist is any other antagonist of EGF or EGFR knownin the art. Each possibility represents a separate embodiment of thepresent invention.

In another embodiment, the EGF or EGFR antagonist is a carboxypeptidaseinhibitor from potato (PCI) protein or a homologue, fragment or mimeticthereof. In another embodiment, the EGF or EGFR antagonist is a sproutyprotein or a homologue, fragment or mimetic thereof. In anotherembodiment, the EGF or EGFR antagonist is an Argos protein or ahomologue, fragment or mimetic thereof. In another embodiment, the EGFor EGFR antagonist is a lefty protein or a homologue, fragment ormimetic thereof. In another embodiment, the EGF or EGFR antagonist is anantibody that recognizes EGF or EGFR, or a fragment or mimetic thereof.In another embodiment, the EGF or EGFR antagonist is small moleculeinhibitor that binds and reduces the activity of EGF or EGFR. In anotherembodiment, the EGF or EGFR antagonist is CRM197. In another embodiment,the EGF or EGFR antagonist is IMC-C225 (ImClone Systems, New York,N.Y.). In another embodiment, the EGF or EGFR antagonist is any otherantagonist of EGF or EGFR known in the art. Each possibility representsa separate embodiment of the present invention.

The EGFR of methods and compositions of the present invention has, inanother embodiment, the sequence:

MRPSGTAGAALLALLAALCPASRALEEKKVCQGTSNKLTQLGTFEDHFLSLQRMFNNCEVVLGNLEITYVQRNYDLSFLKTIQEVAGYVLIALNTVERIPLENLQIIRGNMYYENSYALAVLSNYDANKTGLKELPMRNLQEILHGAVRFSNNPALCNVESIQWRDIVSSDFLSNMSMDFQNHLGSCQKCDPSCPNGSCWGAGEENCQKLTKIICAQQCSGRCRGKSPSDCCHNQCAAGCTGPRESDCLVCRKFRDEATCKDTCPPLMLYNPTTYQMDVNPEGKYSFGATCVKKCPRNYVVTDHGSCVRACGADSYEMEEDGVRKCKKCEGPCRKVCNGIGIGEFKDSLSINATNIKHFKNCTSISGDLHILPVAFRGDSFTHTPPLDPQELDILKTVKEITGFLLIQAWPENRTDLHAFENLEIIRGRTKQHGQFSLAVVSLNITSLGLRSLKEISDGDVIISGNKNLCYANTINWKKLFGTSGQKTKIISNRGENSCKATGQVCHALCSPEGCWGPEPRDCVSCRNVSRGRECVDKCNLLEGEPREFVENSECIQCHPECLPQAMNITCTGRGPDNCIQCAHYIDGPHCVKTCPAGVMGENNTLVWKYADAGHVCHLCHPNCTYGCTGPGLEGCPTNGPKIPSIATGMVGALLLLLVVALGIGLFMRRRHIVRKRTLRRLLQERELVEPLTPSGEAPNQALLRILKETEFKKIKVLGSGAFGTVYKGLWIPEGEKVKIPVAIKELREATSPKANKEILDEAYVMASVDNPHVCRLLGICLTSTVQLITQLMPFGCLLDYVREHKDNIGSQYLLNWCVQIAKGMNYLEDRRLVHRDLAARNVLVKTPQHVKITDFGLAKLLGAEEKEYHAEGGKVPIKWMALESILHRIYTHQSDVWSYGVTVWELMTFGSKPYDGIPASEISSILEKGERLPQPPICTIDVYMIMVKCWMIDADSRPKFRELIIEFSKMARDPQRYLVIQGDERMHLPSPTDSNFYRALMDEEDMDDVVDADEYLIPQQGFFSSPSTSRTPLLSSLSATSNNSTVACIDRNGLQSCPIKEDSFLQRYSSDPTGALTEDSIDDTFLPVPEYINQSVPKRPAGSVQNPVYHNQPLNPAPSRDPHYQDPHSTAVGNPEYLNTVQPTCVNSTFDSPAHWAQKGSHQISLDNPDYQQDFFPKEAKPNGIFKGSTAENAEYLRVAPQSSE FIGA (GenBankAccession No: NM_005228; SEQ ID No: 8). In another embodiment, the EGFRhas a sequence selected from the sequences set forth in GenBank entriesNM_201282, NM_201283, NM_201284, BC094761, AF288738, AY588246, AY573061,X17054, AF125253, U48722, K03193, and AY698024. In another embodiment,the EGFR is encoded by a nucleic acid molecule having a sequence setforth in the one of the above GenBank entries. In another embodiment, abiologically active fragment of an EGFR is utilized in a method of thepresent invention. Each possibility represents a separate embodiment ofthe present invention.

The EGF of methods and compositions of the present invention has, inanother embodiment, the sequence:MLLTLIILLPVVSKFSFVSLSAPQHWSCPEGTLAGNGNSTCVGPAPFLIFSHGNSIFRIDTEGTNYEQLVVDAGVSVIMDFHYNEKRIYWVDLERQLLQRVFLNGSRQERVCNIEKNVSGMAINWINEEVIWSNQQEGIITVTDMKGNNSHILLSALKYPANVAVDPVERFIFWSSEVAGSLYRADLDGVGVKALLETSEKITAVSLDVLDKRLFWIQYNREGSNSLICSCDYDGGSVHISKHPTQHNLFAMSLFGDRIFYSTWKMKTIWIANKHTGKDMVRINLHSSFVPLGELKVVHPLAQPKAEDDTWEPEQKLCKLRKGNCSSTVCGQDLQSHLCMCAEGYALSRDRKYCEDVNECAFWNHGCTLGCKNTPGSYYCTCPVGFVLLPDGKRCHQLVSCPRNVSECSHDCVLTSEGPLCFCPEGSVLERDGKTCSGCSSPDNGGCSQLCVPLSPVSWECDCFPGYDLQLDEKSCAASGPQPFLLFANSQDIRHMHFDGTDYGTLLSQQMGMVYALDHDPVENKIYFAHTALKWIERANMDGSQRERLIEEGVDVPEGLAVDWIGRRFYWTDRGKSLIGRSDLNGKRSKIITKENISQPRGIAVHPMAKRLFWTDTGINPRIESSSLQGLGRLVIASSDLIWPSGITIDFLTDKLYWCDAKQSVIEMANLDGSKRRRLTQNDVGHPFAVAVFEDYVWFSDWAMPSVIRVNKRTGKDRVRLQGSMLKPSSLVVVHPLAKPGADPCLYQNGGCEHICKKRLGTAWCSCREGFMKASDGKTCLALDGHQLLAGGEVDLKNQVTPLDILSKTRVSEDNITESQHMLVAEIMVSDQDDCAPVGCSMYARCISEGEDATCQCLKGFAGDGKLCSDIDECEMGVPVCPPASSKCINTEGGYVCRCSEGYQGDGIHCLDIDECQLGVHSCGENASCTNTEGGYTCMCAGRLSEPGLICPDSTPPPHLREDDHHYSVRNSDSECPLSHDGYCLHDGVCMYIEALDKYACNCVVGYIGERCQYRDLKWWELRHAGHGQQQKVIVVAVCVVVLVMLLLLSLWGAHYYRTQKLLSKNPKNPYEESSRDVRSRRPADTEDGMSSCPQPWFVVIKEHQDLKNGGQPVAGEDGQAADGSMQPTSWRQEPQLCGMGTEQGCWIP VSSDKGSCPQVMERSFHMPSYGTQTLEGGVEKPHSLLSANPLWQQRALDPPHQMELT Q (GenBankAccession No: NM_001963; SEQ ID No: 9). In another embodiment, the EGFhas a sequence selected from the sequences set forth in GenBank entriesBC093731, AY548762, and X04571. In another embodiment, the EGF isencoded by a nucleic acid molecule having a sequence set forth in theone of the above GenBank entries. In another embodiment, a biologicallyactive fragment of an EGF is utilized in a method of the presentinvention. Each possibility represents a separate embodiment of thepresent invention.

In another embodiment, a method of the present invention furthercomprises the step of contacting the skin region of interest with aHedgehog protein. In another embodiment, a method of the presentinvention further comprises the step of contacting the skin region ofinterest with a nucleotide encoding a Hedgehog protein. In anotherembodiment, a method of the present invention further comprises the stepof contacting the skin region of interest with an activator of aHedgehog protein. Each possibility represents a separate embodiment ofthe present invention.

In one embodiment, the methods of the present invention further comprisethe step of administering a 5 alpha-reductase type 2 inhibitor, which inone embodiment, is Finasteride or, in another embodiment, turosteride.

In another embodiment, the methods of the present invention furthercomprise the step of administering a reductase inhibitor., which in oneembodiment is an FCE—dual inhibitor, which in one embodiment is FCE28260; FCE 28175, or FCE 27837; in another embodiment is an MKinhibitor, which in one embodiment, is MK 0434, MK 0963, or MK 386; inanother embodiment, is an FK Nonsteroidal Inhibitor, which in oneembodiment is FK 143; and in another embodiment is a LY NonsteroidalInhibitor, which in one embodiment, is LY 191704; and in anotherembodiment, is a SK&F Inhibitor, which in one embodiment, is SK&F105657.

In another embodiment, the methods of the present invention furthercomprise the step of administering an additional composition. In oneembodiment, the composition is Dutasteride (Avodart®, G1198745),Finasteride (Propecia®, Proscar®), Turosteride, Azelaic acid, Zincsulphate, CS 891, or a combination thereof.

In another embodiment, the methods of the present invention furthercomprise the step of administering an antiandrogen, which in oneembodiment is Spironolactone (Aldactone®), Flutamide (Euflex®,Eulexin®), Casodex, Inocoterone, an RU Antiandrogen, TZP-4238, Win49596, Fluridil (Eucapil®), or a combination thereof.

In another embodiment, the methods of the present invention furthercomprise the step of administering a K+ Channel Opener, which in oneembodiment, is minoxidil (Rogaine®), Diazoxide, Cromakalim, Pinacidil,or a combination thereof.

In another embodiment, the methods of the present invention furthercomprise the step of administering a vasodilator, which in oneembodiment, is minoxidil (Rogaine®).

In another embodiment, the methods of the present invention furthercomprise the step of administering an estrogen blocker, which in oneembodiment, is an ICI Estrogen Blocker.

The subject of methods of the present invention, is, in anotherembodiment, a human. In another embodiment, the subject is a rodent, inone embodiment, a mouse, in another embodiment, a rat. In anotherembodiment, the subject is a mammal. In another embodiment, the subjectis a vertebrate. In another embodiment, the subject is feline, canine,ovine, or bovine. In another embodiment, the subject is a male. Inanother embodiment, the subject is a female. In another embodiment, thesubject is any other subject known in the art. Each possibilityrepresents a separate embodiment of the present invention.

In another embodiment, the subject is an adult. In one embodiment,“adult” refers to an age greater than about 18 years. In anotherembodiment, “adult” refers to an age greater than about 20 years. Inanother embodiment, “adult” refers to an age greater than about 25years. In another embodiment, “adult” refers to an age greater thanabout 30 years. In another embodiment, “adult” refers to an age greaterthan about 35 years. In another embodiment, “adult” refers to an agegreater than about 40 years. In another embodiment, “adult” refers to anage greater than about 45 years.

In another embodiment, the subject is elderly. In one embodiment,“elderly” refers to an age greater than about 45 years. In anotherembodiment, “elderly” refers to an age greater than about 50 years. Inanother embodiment, “elderly” refers to an age greater than about 55years. In another embodiment, “elderly” refers to an age greater thanabout 60 years. In another embodiment, “elderly” refers to an agegreater than about 65 years. In another embodiment, “elderly” refers toan age greater than about 70 years.

In another embodiment, the first subject, or, where applicable, both thefirst subject and the second subject, is a laboratory animal. In anotherembodiment, the subject(s) is/are mice. In another embodiment, thesubject(s) is/are rats. In another embodiment, the subject(s) is/aregerbils. In another embodiment, the subject(s) is/are hamsters. Inanother embodiment, the subject(s) is/are guinea pigs. In anotherembodiment, the subject(s) is/are rabbits. In another embodiment, thesubject(s) is/are pigs. In another embodiment, the subject(s) is/aredogs. In another embodiment, the subject(s) is/are cats. In anotherembodiment, the subject(s) is/are primates. In another embodiment, thesubject(s) is/are any other laboratory animal known in the art. Eachpossibility represents a separate embodiment of the present invention.

In one embodiment, the subject is contacted with FGF9, or in anotherembodiment, with a composition comprising FGF9. In another embodiment,FGF9 or a composition comprising FGF9 is administered to a subject.

“Contacting” as used herein refers, in another embodiment, to bringingskin, in one embodiment, scalp, eyebrow, etc, into to contact with acompound, factor, cell, etc. In another embodiment, the term refers toembedding the compound, factor, cell, etc into the skin region ofinterest. In another embodiment, the term refers to injecting thecompound, factor, cell, etc into the skin region of interest. In anotherembodiment, term refers to any other type of contacting known in theart. Each possibility represents a separate embodiment of the presentinvention.

In another embodiment, the step of contacting in methods of the presentinvention comprises directly contacting the skin region of interest withthe compound, RNA, protein, etc. In another embodiment, the step ofcontacting comprises indirectly contacting the skin region of interestvia contacting another site or tissue of the subject, after which thecompound, RNA, or protein is transported to the skin region of interestby a biological process; e.g, diffusion, active transport, orcirculation in a fluid such as the blood, lymph, interstitial fluid,etc. Each possibility represents a separate embodiment of the presentinvention.

In one embodiment, other fibroblast growth factors may be used in themethods of the present invention. In one embodiment, FGF1, FGF2, FGF3,FGF4, FGF5, FGF6, FGF7, FGF8, FGF9, FGF10, or a combination thereof maybe used in the methods of the present invention. In one embodiment, FGF1through FGF10 all bind fibroblast growth factor receptors (FGFRs). Inone embodiment, FGF1 is known as acidic fibroblast growth factor, andFGF2 is also known as basic fibroblast growth factor.

In another embodiment, FGF11, FGF12, FGF13, or FGF14, may be used in themethods of the present invention. In one embodiment, FGF11, FGF12,FGF13, and FGF14 are known as FGF homologous factors 1-4 (FHF1-FHF4),and in another embodiment, have distinct functional differences comparedto the FGFs. In one embodiment, these factors possess remarkably similarsequence homology, they do not in one embodiment, bind FGFRs and areinvolved in intracellular processes unrelated to the FGFs. In oneembodiment, this group is also known as “iFGF”.

In another embodiment, FGF16, FGF17, FGF18, FGF19, FGF20, FGF21, FGF22,or FGF23 may be used in the methods of the present invention. In oneembodiment, FGF15/FGF19, FGF21 and FGF23 have systemic rather than localeffects.

Pharmaceutical Compositions

In another embodiment, methods of the present invention compriseadministering a pharmaceutical composition comprising FGF9 or anup-regulator of SHH and/or its analog, derivative, isomer, metabolite,pharmaceutically acceptable salt, pharmaceutical product, hydrate,N-oxide, or any combination thereof; and a pharmaceutically acceptablecarrier. Each possibility represents a separate embodiment of thepresent invention.

The pharmaceutical compositions containing FGF9 or an up-regulator ofSHH can, in another embodiment, be administered to a subject by anymethod known to a person skilled in the art, such as topically,parenterally, paracancerally, transmucosally, transdermally,intramuscularly, intravenously, intradermally, subcutaneously,subepidermally, intraperitonealy, intraventricularly, intra-arteriolly,intravascularly, intracranially, intravaginally, intrarectally, orintratumorally. Each possibility represents a separate embodiment of thepresent invention. In one embodiment, the dosage regimen will bedetermined by skilled clinicians, based on factors such as exact natureof the condition being treated, the severity of the condition, the ageand general physical condition of the patient, body weight, and responseof the individual patient, etc.

In another embodiment, the pharmaceutical compositions are administeredorally, and are thus formulated in a form suitable for oraladministration, i.e. as a solid or a liquid preparation. Suitable solidoral formulations include tablets, capsules, pills, granules, pelletsand the like. Suitable liquid oral formulations include solutions,suspensions, dispersions, emulsions, oils and the like. In oneembodiment of the present invention, the FGF9 or a molecule thatupregulates SHH (e.g., SHH agonist) as provided herein composition isformulated in a capsule. In another embodiment, the compositions of thepresent invention comprise, in addition to FGF9 or a molecule thatupregulates SHH (e.g., SHH agonist) as provided herein an inert carrieror diluent, or a hard gelating capsule.

In another embodiment, the pharmaceutical compositions are administeredtopically to body surfaces and are thus formulated in a form suitablefor topical administration. Suitable topical formulations include gels,ointments, creams, lotions, drops, gels; pastes; powders; aerosolsprays; syrups or ointments on sponges or cotton applicators; andsolutions or suspensions in an aqueous liquid, non-aqueous liquid,oil-in-water emulsion, or water-in-oil liquid emulsion, and the like.Because of its ease of administration, a cream, lotion, or ointmentrepresents the most advantageous topical dosage unit form, in which caseliquid pharmaceutical carriers may be employed in the composition. Thesecreams, lotions, or ointments, may be prepared as rinse-off or leave-onproducts, as well as two stage treatment products for use with otherskin cleansing or managing compositions. In a preferred embodiment, thecompositions are administered as a rinse-off product in a higherconcentration form, such as a gel, and then a leave-on product in alower concentration to avoid irritation of the skin. Each of these formsis well understood by those of ordinary skill in the art, such thatdosages may be easily prepared to incorporate the pharmaceuticalcomposition of the invention. In one embodiment, a delayed release patchmay be used for administration of the composition of the invention. Fortopical administration, the composition or its physiologically toleratedderivatives such as salts, esters, N-oxides, and the like are preparedand applied as solutions, suspensions, or emulsions in a physiologicallyacceptable diluent with or without a pharmaceutical carrier.

Ointment preparations may be roughly classified into fat/oil typeointments, emulsified ointments, water-soluble ointments and suspendedointments according to the type of the base (vehicle) used therefor. Anointment may comprise, for example, fats, fatty oils, lanolin, vaseline,paraffins, waxes, resins, plastics, glycols, higher alcohols, glycerol,water, emulsifiers, suspending agents or other appropriate additives asa diluent, carrier or as a vehicle. Manufacture of an ointmentcomprises, for example, adding the compound of the present invention tothe appropriate additives, diluents, carriers or vehicles followed bymixing to make the mixture homogeneous.

For parenteral application, particularly suitable are injectable,sterile solutions, preferably oily or aqueous solutions, as well assuspensions, emulsions, or implants, including suppositories and enemas.Ampoules are convenient unit dosages. Such a suppository may compriseany agent described herein.

For application by inhalation, solutions or suspensions of the compoundsmixed and aerosolized or nebulized in the presence of the appropriatecarrier suitable. Such an aerosol may comprise any agent describedherein.

For enteral application, particularly suitable are tablets, dragees,liquids, drops, or capsules. In one embodiment, a sweetened vehicle isemployed when a syrup, elixir, or the like is used for enteralapplication.

For liquid formulations, pharmaceutically acceptable carriers are, inanother embodiment, aqueous or non-aqueous solutions, suspensions,emulsions or oils. Examples of non-aqueous solvents are propyleneglycol, polyethylene glycol, and injectable organic esters such as ethyloleate. Aqueous carriers include, in another embodiment, water,alcoholic/aqueous solutions, emulsions or suspensions, including salineand buffered media. Examples of oils are those of petroleum, animal,vegetable, or synthetic origin, for example, peanut oil, soybean oil,mineral oil, olive oil, sunflower oil, and fish-liver oil.

In another embodiment, the pharmaceutical compositions are administeredby subcutaneous implantation of a pellet. In another embodiment, thepellet provides for controlled release of the composition of theinvention over a period of time.

In one embodiment, the pharmaceutical compositions arecontrolled-release compositions, i.e. compositions in which thecomposition is released over a period of time after administration.Controlled- or sustained-release compositions include, in anotherembodiment, formulation in lipophilic depots (e.g. fatty acids, waxes,oils). In another embodiment, the composition is an immediate-releasecomposition, i.e. a composition in which all the composition is releasedimmediately after administration. Sustained or directed releasecompositions can be formulated, e.g., liposomes or those wherein theactive compound is protected with differentially degradable coatings,e.g., by microencapsulation, multiple coatings, etc. It is also possibleto freeze-dry the new compounds and use the lyophilisates obtained, forexample, for the preparation of products for injection.

In one embodiment, compositions of this invention are pharmaceuticallyacceptable. In one embodiment, the term “pharmaceutically acceptable”refers to any formulation which is safe, and provides the appropriatedelivery for the desired route of administration of an effective amountof at least one compound for use in the present invention. This termrefers to the use of buffered formulations as well, wherein the pH ismaintained at a particular desired value, ranging from pH 4.0 to pH 9.0,in accordance with the stability of the compounds and route ofadministration.

In one embodiment, FGF9 or upregulators of SHH used in the methods ofthis invention may be administered alone or within a composition. Inanother embodiment, compositions comprising FGF9 or upregulators of SHHin admixture with conventional excipients, i.e. pharmaceuticallyacceptable organic or inorganic carrier substances suitable forparenteral, enteral (e.g., oral) or topical application which do notdeleteriously react with the active compounds may be used. In oneembodiment, suitable pharmaceutically acceptable carriers include butare not limited to water, salt solutions, alcohols, gum arabic,vegetable oils, benzyl alcohols, polyethylene glycols, gelatine,carbohydrates such as lactose, amylose or starch, magnesium stearate,talc, silicic acid, viscous paraffin, white paraffin, glycerol,alginates, hyaluronic acid, collagen, perfume oil, fatty acidmonoglycerides and diglycerides, pentaerythritol fatty acid esters,hydroxy methylcellulose, polyvinyl pyrrolidone, etc. In anotherembodiment, the pharmaceutical preparations can be sterilized and ifdesired mixed with auxiliary agents, e.g., lubricants, preservatives,stabilizers, wetting agents, emulsifiers, salts for influencing osmoticpressure, buffers, coloring, flavoring and/or aromatic substances andthe like which do not deleteriously react with the active compounds. Inanother embodiment, they can also be combined where desired with otheractive agents, e.g., vitamins.

In one embodiment, the therapeutic compositions of the present inventioncomprise an FGF9 composition and one or more additional compoundseffective in preventing or treating dermatologic conditions such asalopecia. In one embodiment, the additional compound is a moisturizer oran emollient, which in one embodiment is petrolatum, white petrolatum,hydrogenated vegetable oil, hydrophilic petrolatum, panthenol, primroseoil, omega-3 fish oils, omega-6 fish oils, linoleic acid, flax seed oil,ceramide, borage oil (linoleic acid), tocopherol (Vitamin E), tocopherollinoleate, dimethicone, glycerine or a combination thereof. In oneembodiment, moisturizers improve the ability of the skin to absorb otheradministered compounds, including inter alia, the compounds for use inthe present invention. In another embodiment, moisturizing agentsminimize or prevent the skin from drying and cracking, therebydecreasing susceptibility of skin to environmental factors that generatefree radicals, thereby preventing additional damage to the skin.

In another embodiment, the additional compound is a topical steroid,which in one embodiment is hydrocortisone, in one embodment 1%hydrocortisone, triamcinolone, fluocinolone acetonide, halcinonide,halobetasol propionate, clobetasol propionate, betamethasonedipropionate, betamethasone valerate, and triamcinolone acetonide or acombination thereof; oral steroids; topical immunomodulators including,inter alia, tacrolimus, pimecrolimus, Ascomycin, cyclosporine, or acombination thereof; antihistamines, which in one embodiment ishydroxyzine or diphenhydramine hydrochloride, Ketotifen, Doxepin;biologics, which in one embodiment comprises Amevive (alefacept),Enbrel, Humira, Raptiva, Remicade, or a combination thereof; or acombination thereof. In another embodiment, the additional compound isan antibiotic, which in one embodiment comprise tetracycline, doxycline,minocycline, cloxacillin, cephalexin, penicillin, clindamycin or acombination thereof. In another embodiment, the additional compound ismethotrexate, tar, coal tar, anthralin, dovonex, salicyclic acid,tazorac, moisturizers, aloe vera, soriatane, accutane, hydrea,mycophenolate mofetil, sulfasalazine, 6-thioguanine, or a combinationthereof. In another embodiment, additional compounds comprise acyclovir,which in one embodiment is particularly effective in patients witheczema herpeticum. In one embodiment, additional compounds to treatseborrheic dermatitis comprise zinc pyrithione, selenium sulfide,sulfur, tar shampoo, flucinolone acetonide solution, triamcinoloneacetonide lotion, ketoconazole cream, other imidazoles, or a combinationthereof.

In another embodiment, the additional compound is an anti-inflammatoryagent, which in one embodiment comprises aspirin, ibuprofen, ketoprofen,naproxen, or a combination thereof. In another embodiment, theadditional compound is a prostaglandin or prostaglandin inhibitor, whichin one embodiment is an inhibitor of PGD2.

In another embodiment, the additional compound is an exfoliant, which inone embodiment comprises an enzymatic exfoliant or a mono- or-poly-hydroxy acid. In one embodiment, the exfoliant is an alpha-hydroxyacid, beta-hydroxy acid, tannic acid, glycolic acid, lactic acid, citricacid, salicylic acid, or a combination thereof. In another embodiment,the additional compound is an analgesic, or anesthetic, while in anotherembodiment it is aloe vera gel, aloe vera, licorice extract, pilewort,Canadian willow root, zinc, allantoin, or a combination thereof. Inanother embodiment, the additional compound is an anti-oxidant.

In one embodiment, fibroblast growth factor-9 protein is administered ata concentration of 10 ng/mL. In another embodiment, fibroblast growthfactor-9 protein is administered at a concentration of 20 ng/mL. Inanother embodiment, fibroblast growth factor-9 protein is administeredat a concentration of 40 ng/mL. In another embodiment, fibroblast growthfactor-9 protein is administered at a concentration of 80 ng/mL. Inanother embodiment, fibroblast growth factor-9 protein is administeredat a concentration of 5 ng/mL. In another embodiment, fibroblast growthfactor-9 protein is administered at a concentration of 3 ng/mL. Inanother embodiment, fibroblast growth factor-9 protein is administeredat a concentration of 1 ng/mL. In another embodiment, fibroblast growthfactor-9 protein is administered at a concentration of between 1 and 50ng/mL. In another embodiment, fibroblast growth factor-9 protein isadministered at a concentration of between 1 and 15 ng/mL. Each doserepresents a separate embodiment.

In general, the doses utilized for the above described purposes willvary, but will be in an effective amount to exert the desired effect. Asused herein, the term “pharmaceutically effective amount” refers to anamount of a FGF9 or other composition for use in the present invention,which will produce the desired alleviation in symptoms or other desiredphenotype in a patient. The doses utilized for any of theabove-described purposes will generally be from 1 to about 1000milligrams per kilogram of body weight (mg/kg), administered one to fourtimes per day, or by continuous IV infusion. In one embodiment, atopical daily dose range, in single or divided doses, for the conditionsdescribed herein is from about 1 mg to 20,000 mg, more preferably about2,000 mg to 16,000 mg, and most preferably about 6,000 mg to 10,000 mgof the active components (i.e., excluding excipients and carriers). Whenthe compositions are dosed topically or intraocularly, they willgenerally be in a concentration range of from 0.1 to about 10% w/v,administered 1-4 times per day. In one embodiment, the compositions foruse in the methods of the present invention are administered topicallytwo times a day.

In one embodiment of the invention, the concentrations of the compoundswill depend on various factors, including the nature of the condition tobe treated, the condition of the patient, the route of administrationand the individual tolerability of the compositions.

In one embodiment, the administering step is via topical administration.In another embodiment, the administering step is via subcutaneousadministration.

In one embodiment, the compound administered as part of methods of thepresent invention is administered systemically. In another embodiment,the compound is administered topically. In another embodiment, thecompound is administered subepidermally. In another embodiment, thecompound is administered subcutaneously. In another embodiment, thecompound is administered transdermally. In another embodiment, thecompound is administered to the site of the abrasion. In anotherembodiment, the compound is administered to the site of the woundinduction. In another embodiment, the compound is administered to thesite of the depilation. In another embodiment, the compound isadministered during wound healing. In another embodiment, the compoundis administered prior to HF neo-genesis. In another embodiment, thecompound is administered during HF neo-genesis. Each possibilityrepresents a separate embodiment of the present invention.

In one embodiment, the route of administration may be directed to anorgan or system that is affected by alopecia. For example, compounds maybe administered topically to treat dermatologic conditions such asalopecia. In another embodiment, the route of administration may bedirected to a different organ or system than the one that is affected bydermatologic conditions such as alopecia. For example, compounds may beadministered parenterally to treat dermatologic conditions such asalopecia. Thus, the present invention provides for the use of FGF9 orother composition for use in the present invention in various dosageforms suitable for administration using any of the routes listedhereinabove.

In one embodiment, the methods of the present invention of testing acompound are repeated using a plurality of subjects, until astatistically significant sample has been tested.

In one embodiment, FGF9 augments hair germ formation in embryonictissue, but is not essential for hair germ formation. In one embodiment,FGF9 is necessary for hair follicle formation and/or size in adulttissue after epidermal disruption.

In one embodiment, the signaling pathway for embryonic hair germformation and for wound-induced hair follicle neogenesis share one ormore components. In another embodiment, the signaling pathway forembryonic hair germ formation and for wound-induced hair follicleneogenesis is not identical. Thus, in one embodiment, FGF9 is essentialfor hair follicle formation in WIHF but not during ED13.5.

In another embodiment, the signaling pathway for hair growth signalsdiffers in different parts of the body. Thus, in one embodiment,embryonic hair germ formation and wound-induced hair follicle neogenesisdiffer in their dependence on FGF9 due to the differences in theirrespective developmental stages and differences in location in the body.

In one embodiment, the combination of FGF9 and wound healing increasesits efficacy as a hair growth promoter. In one embodiment, FGF9application alone causes epidermal thickening.

In another embodiment, the invention provides a method of treating hairloss or regenerating hair follicles in a subject comprising the step ofdisrupting the epidermis in the region of said hair loss in saidsubject. In some embodiments, the method further comprises the step ofrecruiting the gamma-delta T cells to the wound epidermis. In anexemplary embodiment, the method further comprises the step ofrecruiting the gamma-delta T cells to the wound epidermis throughcytokines.

EXAMPLES Experimental Details Depilation and Epidermal Abrasion

Mice were anesthetized with an injection of sodium pentobarbital beforethe hair on the back was clipped and depilated with Nair(Carter-Wallace, New York, N.Y.), then epidermis was removed using arotating felt wheel as described by Argyris T, J Invest Dermatol, 75:360-362, 1980). After scrubbing with 70% ethanol and drying under anincandescent lamp, the basal and supra-basal layers in an area of (1.5cm)² cm of the inter-follicular epidermis were removed by carefulabrasion with a felt wheel mounted on a Dremel Moto-tool (Racine, Wis.).After abrasion, the skin was shiny and smooth, and there was no blood.One day later, the abraded area was covered by a fibrin crust, whichfell off after 3-7 days, exposing the newly regenerated epidermis. Agroup of control mice was sacrificed immediately after abrasion toconfirm microscopically the complete removal of the interfollicularepidermis.

Punch Wound and Excisional Wound Induction

The backs of 21-day-old mice were depilated as described for Example 1and sterilized with alcohol, followed by 1% iodine solution. Punchwounds, 4 mm in diameter, were induced using a dermal biopsy punch, downto, but not through, the muscle fascia. Excisional wounds were fullthickness and 1 cm in diameter; skin and panniculus carnosus was excisedusing fine surgical scissors.

Immunohistochemistry

Skin samples were fixed in PBS-buffered 10% formalin. Six-micron thickparaffin sections were cut and stained, where applicable, withantibodies.

Whole Mounting and Immunofluorescence

HF whole mounts were obtained by incubating fresh skin with EDTA (20 mMin PBS) at 37° C. overnight, then separating the epidermis and dermis.Epidermis was then fixed in 10% formalin for 10 min, room temperature(RT). Dermis was fixed in acetone overnight, RT. After rinsing with PBS,whole mounts were stained with antibodies for immunohistochemistry(schematically depicted in FIG. 12) and were imaged using a Leicaconfocal microscope.

Statistics

Hair follicle numbers are expressed as mean±s.d. The student'stwo-tailed t-test function in Excel was used to calculate P values.

Embryonic Mouse Skin Culture Protocol

The following materials were used: Center well dishes (Fisher08-772-12); Metal grids (Goodfellow 688-485-21); Nitrocellulose filters(Millipore AABP04700); Media: DMEM+5% FBS+1× Pen/Strep.

Gestational day 13.5 timed pregnant mothers (Charles River) wereordered. Center well dishes were set up with 2 ml media/dish. Metal gridwas placed in center well. Dishes were stored in incubator so the mediawarmed to 37° C. Nitrocellulose filter were cut into rectangles andplaced in a beaker of dH₂O on a hot plate. Water was allowed to boil andthen filters were boiled for 10 min.

Two petri dishes with sterile PBS were prepared. Mothers were euthanizedand embryos were dissected out in the sac. Embryos were placed into onepetri dish. The embryos were dissected out of the sac and placed in asecond clean petri dish with sterile PBS. The dish of embryos wereplaced on ice. Dorsal skin was dissected from the embryo under adissecting scope, in a clean petri dish containing sterile PBS.

The crown-rump length of the embryo was checked with a ruler to ensureit is E13.5 stage. (˜10-10.3 mm). The head of the embryo was removedwith micro dissecting scissors. A smaller pair of micro dissectingscissors were used to make incisions along both sides of the back, abovethe limbs. A third incision was made across the back, anterior to thetail. Using fine tipped Dumont tweezers, the skin was peeled from thetail towards the head. The skin was laid onto the black side ofnitrocellulose filter, as flat as possible. The nitrocellulose filterwas placed onto metal grid so that the skin is at the liquid-airinterface. The dish was incubated at 37° C. When all skins weredissected, compounds were added to culture media (if necessary), andreturned to the incubator. Skins were cultured for up to 3 days.Placodes started to develop on E14.5.

Example 1 FGF9 Expressed in Early Period of Hair Germ Formation

FGF9 mRNA expression was evaluated in regenerated epidermis byquantitative real time-PCR. FGF9 was expressed at higher levels prior tothe earliest stages of hair follicle regeneration at Day 1 after scabdetachment (SD; which occurs at reepithelialization) compared to Day 5after scab detachment when follicles have formed (FIG. 1). Skin γδT-cells (detected by immunostaining using antibodies againstγδTCreceptor) repopulate the reepithelialized epidermis by SD7 (FIG. 2,left panel) and these cells express FGF9 protein at SD1 (red dendriticcell in epidermis, FIG. 2, right panel, and FIG. 3).

Thus, FGF9 was selectively expressed prior to hair germ formation(during the undifferentiated period) rather than during differentiation.Skin γδ T cells appeared to be the source of FGF9, which suggestsinflammatory cells may have a role in Wound-induced hair follicleneogenesis (WIHN).

Example 2 FGF9 Expressed in Embryonic Day 14 (E14) Skin

FGF9 (red staining) is expressed by γδTC (green staining) in embryonicday 14 (E14) skin (FIG. 4).

Example 3 FGF9 Plays a Role in Wound-Induced Hair Follicle Neogenesis(WIHN)

Anti-FGF9 neutralization experiment in adult mice

3 week-old (adult) C57BL/6 mice were subjected to the wounding model asdescribed hereinabove. Mice then received subepidermal injections of 50μl of 10 μg/ml anti-FGF9 or IgG2a isotype control on days SD1-SD4.Tissue samples were taken and analyzed at SD5.

Immunoblots were used to verify the specificity of the anti-FGF9neutralization antibody. Mouse FGF9 has 198 bp and greater than 99%homology with human FGF9 (with only one amino acid difference). FGF9exists in both monomer (25-27 kd) and dimer forms. Immunoblotsdemonstrated the presence of both the 26 Kd monomer and the 52 Kd dimmerforms in E14.5 mouse embryonal whole cell lysates, as well as in controlsamples containing recombinant hFGF9 (FIG. 5).

Mice receiving anti-FGF9 antibody had significantly lower hair folliclenumbers on SD5 than IgG2a controls (FIG. 6). Thus, FGF9 plays a role inwound-induced hair follicle neogenesis.

The developmental stages of the hair follicles were quantitated asdescribed in Paus R et al., J Invest Dermatol 1999. There was a decreasein mature hair follicles and an increase in immature hair follicles inthe anti-FGF9 treated group (FIG. 7).

Example 4 FGF9 Plays a Role in Embryonic Skin Development

Scheduled pregnant C57BL/6 mice were sacrificed at E13.5, and embryonicwhole back skin was dissected. E13.5 skin was cultured for three daysfloated on filter paper with metal grid.

To determine the role of FGF-9 in hair follicle neogenesis in embryonicskin, embryonic skin explant cultures were treated for three days withrecombinant human (rh)FGF9 (control, 10, 20, or 40 ng/mL) or with ananti-FGF9 neutralizing antibody (control, 10, 20, or 40 μg/mL) or IgG2aisotype control (10, 20, 40 μg/mL). Alkaline phosphatase (AP) for dermisimmunostaining (FIG. 10) and K17 was used for epidermis immunostaining(FIG. 12).

Hair germ counting was performed at three separate fields per sample andwas evaluated per mm² (FIG. 8). q-PCR for Shh, Ptch1, Ptch2, Gli1, andGli2 was performed after 24 h of rhFGF9 treatment.

Real-Time PCR Protocol

The following materials were used: RNeasy® fibrous tissue mini kit(Qiagen, 74704); High capacity cDNA reverse transcription kit (AppliedBiosystems, P/N 4368814); Taqman® Fast universal PCR master mix (2×)(Applied Biosystems, P/N 4352042); Applied Biosystems StepOne™ real-timePCR system; (Applied Biosystems, P/N 4376373); MicroAmp™ 48-well opticaladhesive film (Applied Biosystems, P/N 4375928); MicroAmp™ 48-wellreaction plate (Applied Biosystems, P/N 4375816).

The following PCR primers were used (Taqman® gene expression assay,Applied Biosystems):

TABLE 1 Target gene Gene name Assay primer ID Reference sequence Fgf9fibroblast growth Mm00442795_m1 NM_013518.3 factor 9 Shh Sonic hedgehogMm00436527_m1 NM_009170.3 Ptch1 patched homolog 1 Mm00436026_m1NM_008957.2 Ptch2 patched homolog 2 Mm00436047_m1 NM_008958.2 Gli1GLI-Kruppel family Mm00494645_m1 NM_010296.2 member GLI1 Gli2GLI-Kruppel family Mm01293116_m1 NM_001081125.1 member GLI2 ACTB actin,beta P/N 4352933E NM_007393.1 (endogenous control)Protocol for q-PCR with Cultured Embryonic Skin Samples

Embryonic skin culture: E13.5 timed pregnant B57BL/6 female mice(Charles-River) were euthanized in CO₂ chamber. Embryos were dissectedand placed in sterile cold PBS on ice.

Preparation: Millipore nitrocellulose membrane (0.5×1.0 cm2); Autoclavemetal grids; Culture dishes (Falcon center-well organ culture dish,35-3037); 5% FBS-DMEM (lx penicillin/streptomycin, not necessary toinactivate FBS).

2.5 mL of culture media was added and metal mesh and nitrocellulosemembrane were set on the individual culture dishes. Embryonic back skinwas dissected. Head & buttock area were cut. Dissection was throughflank in a caudo-cranial direction. Dissected back skin was loaded onMillipore membrane (dermal side down). The samples were prepared intriplicate per needed for each concentration. Skin samples were culturedfor 24 hr at 37° C. in 5% CO₂.

RNA Isolation & cDNA Preparation

Skin samples were incubated in 20 mM EDTA for 10 min. Epidermis anddermis were separated with fine-tipped tweezers under a dissectingmicroscope, respectively.

Samples were disrupted with a homogenizer and total RNA extracted withRNeasy® fibrous tissue mini kit (Qiagen, 74704) following manufacturer'sinformation.

RNA concentration was measured by spectrophotometer and then convertedto gg of total RNA to cDNA using High capacity cDNA reversetranscription kit (Applied Biosystems, P/N 4368814) with program inthermal cycler.

Real-time PCR

PCR running program was set up and arranged the reaction plate layoutwith provided StepOne software in comparative CT (ΔΔCT) method. Thereaction mixture of target gene and β-actin endogenous control wereprepared together in triplicate. cDNA template was diluted from stock tofinal total cDNA amount of 30-50 ng in 2 μl.

Reaction Mix Components

Component Volume (μl) for 1 reaction Taqman ® Fast universal 10.0 PCRmaster mix (2X) PCR primers 1.0 (Taqman ® gene expression assay) H2O 7.0cDNA template 2.0 Total volume 20.0

2. Prepare the reaction plate: A reaction volume of 20 μl/well is addedon 48-well reaction plate. The plate is sealed tightly with opticaladhesive film.

3. Load the plate into StepOne instrument and start the programmedreaction.

4. Analyze the results with the StepOne software and obtain relativequantitation data of gene expression.

The effect of rhFGF9 treatment for three days in the dermis of embryonicskin explant culture (E13.5) was dose-dependent, with 10 ng/mL and 20ng/ml resulting in an increase in hair germ number/mm², while a 40 ng/mLdose resulted in decreased hair germ number/mm² (FIGS. 9-10). On theother hand, there was no discernable effect of anti-FGF9 neutralizingantibody treatment for three days in the epidermis or dermis ofembryonic skin explant culture (E13.5; FIGS. 11-13).

24-hr treatment of E13.5 embryonic skin explant culture with 10 ng/mL ofrhFGF9 resulted in increases in markers of embryonic hair follicledevelopment including sonic hedgehog (Shh), Ptch1, Ptch2, and Gli1,particularly in the epidermis (FIGS. 14-15).

Fibroblast growth factor 9 increases hair follicle formation wheninjected into the wound after healing. This is just prior to and duringthe time when new hair follicles are forming. FGF9 also increases hairfollicle formation during hair follicle development by using embryonicmouse skin explanted in culture. These findings support the notion thatwounding converts the epidermis to a “receptive” state in which itresponds to exogenous factors.

Example 5 Overexpression of FGF9 in Basal Keratinocytes

The gain of function mutant TRE-fgf9-IRES-eGfp;K5-rtTA (×Ptch1-LacZreporter) (White et al., Development 133, 1507-1517, 2006; Diamond, etal. (2000) J. Invest. Dermatol. 115, 788-794, both incorporated hereinby reference) is used to validate that early FGF9 expression in hairneogenesis stage would enhance hair follicle development and to confirmthat FGF9 is upstream of Shh signaling.

Example 6 Deletion of FGF9 Expression in γδ T Cells

Deletion of FGF9 expression in γδ T cells is accomplished using the lossof function mutant FGF9flox/flox;lck-cre to selectively delete FGF9using T-cell targeting lck-cre promoter. The Lck-Cre uses the proximalpromoter of the Lck (lymphocyte protein tyrosine kinase) gene, which isfirst expressed early in thymocyte development at the double negativestage. After T cells fully mature, the level of expression of thistransgene decreases by approximately 10 fold. This particular mouse geneshows a high degree of expression of the transgene in the thymus and hasbeen found to bring about the selective deletion of genes flanked byloxP targeting sequences in almost all early thymocytes. It thus is usedto delete a specific gene in the T cell lineage starting at the doublenegative stage. Since the homozygous Lck-Cre mice strains are crossed toa strain containing a floxed FGF9 and offspring with deleted FGF9 in theT cell lineage are obtained. Control animals are obtained in the samelitter by typing for the presence or absence of the floxed gene ingenomic DNA tail samples. This system is described in more detail in Leeet al., Immunity November 2001:15(5) 763-74, which is incorporatedherein by reference.

Example 7 K17-EGFP Reporter Mice

K17-eGFP reporter mice (Bianchi et al., Mol Cell Biol., 2005 August;25(16): 7249-7259, incorporated herein by reference) are used to confirmthe accumulation of FGF9-producing γδ T-cells around newly developinghair germs.

Example 8 FGF9 Mediates Hair Follicle Neogenesis Through Epidermal γδ TCells

Understanding molecular mechanisms responsible for hair follicleregeneration during wound healing raises the opportunity to develop newtreatments for hair loss and other skin disorders. Here, it is clearlyshown that Fibroblast Growth Factor 9 (Fgf9) modulates hair follicleformation following wounding of adult mice. Forced overexpression ofFgf9 in the newly formed wound epidermis results in a 2-3-fold increasein the number of neogenic hair follicles. Remarkably, during woundhealing in normal mice, γδ T cells, which reside in the epidermis, serveas the primary source for Fgf9. Specific deletion of the Fgf9 gene in Tcells using Lck-Cre;floxed fgf9 transgenic mice results in a markedreduction of hair follicle neogenesis following wounding. Similarly,mice lacking γδ T cells demonstrate severe impairment of follicularneogenesis. Overall, these findings explain the robustness of hairfollicle regeneration in mouse compared to human and highlight theimportant relationship between the immune system and tissueregeneration.

Materials and Methods:

Mice and Wounding.

Full thickness excision (FTE) of skin was performed on the back ofC57BL/6J mice (Jackson laboratory) under ketamine/zylazine anesthesia aspreviously described (1). Three-week-old mice were used for allexperiments with a 1×1 cm² FTE, except as indicated. Timed pregnantC57BL/6 female mice of gestational day 13.5 (Charles River) wereutilized for embryonic skin explant culture. K14-rtTA mice harboring thedoxycycline-sensitive transactivator were mated toTRE-Fgf9-IRES-eGfpmice. Both K14-rtTA and K14rtTA/TRE-Fgf9 mice were fedDox-containing food (Bio-SERV) for 4 days after completereepithelization. Deletion of FGF9 expression in γδ T cells wasaccomplished using Fgf9 flox/flox mated to Ick-cre mice (JacksonLaboratory) with T-cell targeting proximal promoter of the lymphocyteprotein tyrosine kinase (lck). γδ T cell null mice (Tcrd^(−/−)) werepurchased from Jackson Laboratory. All animal protocols were approved bythe University of Pennsylvania IACUC.

Whole-Mount Hair Follicle Neogenesis Assay.

Healed skin was taken at day 5 after reepithelization. Whole-mount hairfollicle neogenesis assays for epidermal KRT17 immunostaining (1:5000,from P. Coulombe) and dermal NBT/BCIP incubation were performed toidentify new hair germs and follicular dermal papillae in wound area aspreviously described.

Real-Time PCR.

Dorsal skins were as day 0 samples or the wounded skin at day 1, 3 and 5after scab detachment after reepithelization (SD), respectively. Theepidermis was separated from dermis by incubation with 4° C. dispaseovernight or 20 mM EDTA for 30 min at 37° C. RNA was isolated usingRNeasy minikit (Qiagen) and then 1 μg of total RNA was converted to cDNAwith a High capacity cDNA kit (Applied Biosystems). All primer setsincluding fgf9 of Taqman gene expression assay were purchased fromApplied Biosystems. Reactions were performed in triplicate and relativeexpression levels were standardized using f3-actin as an internalcontrol. The results were analyzed using StepOne program.

Immunostaining.

Reepithelialized skin after wounding was placed either frozen in OCT(Tissue-Tek). Staining for FGF9 (1:200; R&D systems) and γδTCR (1:100;GL3, BD Bioscience) were performed on 8 μm frozen section.Immunohistochemisty with antibodies against BrdU (1:500; Harlan-Seralab)was done as previously described. For pulse-chase experiments, BrdU(Sigma) was administered 2 hr before sample preparation.

Isolation of DETCs and Activation of the Cells.

Epidermal cell suspension was prepared from C57BL6 mice and wasincubated overnight at 37° C. in complete DMEM containing 20U/ml ofrecombinant mouse IL-2 (mIL-2) to allow surface receptor re-expressionas described. DETCs were isolated by FACS sorting with PE-γδTCR (GL3,Abcam) and allophycocyanin-Thy1.2 (BD Bioscience) staining. The isolatedDETCs were cultured in RPMI-1640 medium supplemented with 10% FCS, 25 mMHEPES, 100 U penicillin, 100 μg streptomycin, 2 mM glutamine, 100 μMnonessential amino acids, 1 mM sodium pyruvate, 50 μM 2-mercaptoethanoland 20 U/ml mIL-2. For cell stimulation, the cells were harvested for 4h in the growth factor-free media excluding FCS and mIL-2 and thenincubated in the media described above supplemented with anti-CD3ε (10μg/ml, eBioscience) at 37° C. for 4, 24 and 48 h. Stimulation wasarrested by the addition of ice-cold PBS and samples were placed on ice.Supernatants were removed and cells were collected with lysis buffer.RNA isolation and subsequent cDNA generation were performed with Geneexpression cells-to C_(T) kit (Applied Biosystems).

Wholemount Epidermal γδT Cell Staining.

Ears were cut from 8-week old C57BL/6J mice and epidermal sheets wereseparated as previously described. Epidermal sheets were incubatedovernight in the growth factor-free media described above or completemedia with 20 U/ml mIL-2 at 37° C. Epidermis was then washed in PBS andfixed in ice-cold acetone for 20 min at −20° C. Primary antibodies ofFGF9 and γδTCR mentioned above were incubated overnight at 4° C. Thefollowing morning, sheets were incubated with secondary antibodies for 1hr and mounted on silane-coated slides.

In Vitro Embryonic Skin Culture.

Embryos at E13.5 were dissected out of the sac and the crown-lump lengthwas checked to ensure exact developmental age. Dorsal skin was dissectedand then cultured for up to 3 days as previously described. Recombinanthuman FGF-9 (0-20 ng/ml, R&D systems) or EDA1 (50 ng/ml, R&D systems) asa positive control were added into culture media. In addition, FGF9neutralization experiment was paralleled with anti-FGF9 antibodyincubation (0-40 μg/ml; MAB273, R&D systems). Epidermal-dermalseparations were performed by incubating skin samples in 20 mM EDTA at37° C. for 5 min. Tissues were homogenized to isolated RNA or harvestedfor wholemount assay as described above. The number of hair follicleswas counted per mm² at 3 different fields of each sample and the meanvalue was calculated.

Neutralization Experiment in Adult Mice.

Reepithelization of epidermis, indicated by scab detachment, wascomplete 10-12 days after FTE. One day after complete reepithelization,50 μl of anti-FGF9 neutralization antibody or IgG isotype control (MAB003) at 10 μg/ml were daily injected just beneath epidermis for 4consecutive days. After then, tissues were harvested at day 5, epidermisand dermis were separated using 20 mM EDTA solution and processed forKRT17 immunostaining and detecting alkaline phosphatase activity,respectively. The number of regenerated hair follicles was characterizedwith respect to their density inside the epidermis. The developmentalstages of the hair follicles were quantified as previously described.

In Vivo Confocal Microscopy.

To chase dynamic process of hair follicle neogenesis, the changes ofnewly formed hair follicle number was quantified using in vivo confocalmicroscope (Vivascope 1500, Lucid). Briefly, surrounding area of healedskin was clipped and adhesive window (Lucid) and ultrasonic transmissiongel (Parker laboratory) were applied under ketamine/zylazine anesthesia.New hair follicles could be visualized and counted at the level beneathepidermal-dermal junction. The number was measured at day 2 afterreepithelization and then every 3 days for 2 weeks.

Results

Fgf9 Expression Significantly Increases after Wounding Prior to HairFollicle Neogenesis:

To define molecular events responsible for hair follicle neogenesisfollowing wounding, we compared gene expression in wounded epidermissoon after reepithelialization (1 and 3 days after scab detachment “SD”)to the initiation of hair follicle neogenesis (SD5). Microarray analysesshowed that Fibroblast growth factor 9 (Fgf9) was significantlyupregulated (4.2 fold) prior to hair follicle germ formation. We furtheranalyzed Fgf9 gene expression changes in reepithelialized epidermisaround the time of hair follicle neogenesis by quantitative RTPCR (FIG.16A). Fgf9 gene expression increased significantly afterreepithelialization until the initial stages of hair follicle neogenesiswhen expression decreased dramatically. These results show that Fgf9 isupregulated in the newly formed epidermis just prior to hair follicleneogenesis presumably at a time when cells are committing to the hairfollicle lineage.

Inhibition of Fgf9 Decreases Hair Follicle Neogenesis.

Fgf9 is a secreted ligand with a known role in lung, kidney and gonaddevelopment, but it has not been previously implicated in hair follicledevelopment or regeneration. Nevertheless, the main receptor for Fgf9 inthe skin, Fgr3b,is expressed in epidermis and is upregulated inregenerated skin after wounding. To address the importance of Fgf9 inhair follicle neogenesis following wounding, we injected Fgf9neutralizing antibody into the reepithelialized skin daily for four days(FIG. 16b , Table 2). Wounds treated with anti-Fgf9 antibody showed asignificant reduction of new hair follicle formation when compared withcontrols. The hair follicles that did form in anti-Fgf9-treated woundswere in immature stages of development (FIG. 19).

Forced Overexpression of Fgf9 in the New Epidermis Increases HairFollicle Formation.

Since blocking Fgf9 inhibited hair follicle neogenesis, we asked whetherincreasing levels of Fgf9 in the wound would promote hair follicleneogenesisfollowing wounding. We used a doxycycline-inducible transgenicmouse (K14rtTAx TRE-Fgf9-IRES-eGfp) to inducibly target Fgf9 expressionto the epidermis following wound re-epithelialization. Administration ofdoxcycline from SD1 to SD4 increased Fgf9 expression 150-fold (FIG. 20)compared to doxycycline treated control mice. This targetedoverexpression of Fgf9 to the epidermis for four days afterreepithelialization led to a marked increase in the number of hairfollicles compared to controls (FIG. 16c , Table2).

TABLE 2 Hair follicle neogenesis assay. The number of new hair follicleswere counted at Day 5 after reepithelization. Hair follicle No. MiceExperiment mice (mean ± SD) No. Range P-value Deletion oflck-cre;Fgf9^(flox/flox)  9.1 ± 16.7 11 0-49 <0.05 FGF9Fgf9^(flox/flox), Fgf9^(flox/+) (Control) 30.7 ± 34.0 15  1-131 in Tcells FGF9 Double transgenic K14rtTA; 168.2 ± 117.1 12  2-189 <0.05overexpression TRE-Fgf9-IRES-eGfp Single transgenic K14rtTA, 64.8 ± 50.321 26-431 TRE-Fgf9-IRES-eGfp (Control) Absence of NS γδ T cells 8-weekold wild-type 43.4 ± 31.7 8 1-87 (1.5 × 1.5 cm² wounding) 24-40 week oldwild-type 36.7 ± 24.5 6 1-76 (1.5 × 1.5 cm² wounding) 8-week old γδ Tcell null mice  9.8 ± 10.1 13 0-27 (1.5 × 1.5 cm² wounding) 24-40 weekoldγδ T cell null mice  7.8 ± 13.7 8 0-39 {close oversize bracket}

0.01 (1.5 × 1.5 cm² wounding) NS: not significant.

indicates data missing or illegible when filed

Fgf9 expression localizes to γδ T cells.

To identify the source of Fgf9 in re-epithelialized skin of normal mice,we immunostained tissue sections of healed skin prior to HFN.Surprisingly, we discovered that γδ T cell receptor-bearing epidermal Tcells (DETC), which repopulate the epidermis, express Fgf9.DETCs appearto be the primary source of Fgf9 in epidermis, with little or nocontribution from keratinocytes or other epithelial residents (FIG.17A). Previous gene expression data from basal keratinocytes(Alpha-6-integrin-positive) isolated by FACS showed an absence of Fgf9expression (NAT BIOTech paper). To further confirm the origin of theFgf9, we treated unwounded ear epidermis with mIL-2 and analysedwholemount preparations for Fgf9 expression by immunofluorescence.IL2-induced DETCs stained strongly with anti-FGF9 antibodies whereasadjacent keratinocytes exhibited background staining (FIG. 21).

To determine if FGF9 is constitutively expressed by DETCs in skin orupregulated following stimulation, DETCs were isolated from skin by cellsorting and were cultured in vitro with anti-CD3 and IL2 as previouslydescribed (havren ref). Fgf9 mRNA levels increased by greater than 10fold within 4 hours, followed by diminution to baseline levels within 24hours. (FIG. 17B). This rapid upregulation contrasts with the muchlonger 48 hour induction period required for expression of FGF7 andFGF10, two factors known to be secreted by DETCs during wound repair andindicates distinct transcriptional regulatory mechanisms.

DETCs are Essential for Hair Follicle Neogenesis.

Since Fgf9 mediates hair follicle neogenesis and DETCs appear to be theprimary source of Fgf9 in re-epithelialized epidermis, we hypothesizedthat activated DETCs repopulate the wound during reepithelialization andsecrete FGF9 to induce hair follicle neogenesis. To better define therole of DETCs in hair follicle neogenesis, we studied Tcrd−/− mice thatfail to develop these cells.

We wounded age-matched wild-type and Tcrd−/− mice at 8 or 24-40 weeks ofage and quantified hair follicle neogenesis. As previously reported,TCRd−/− mice showed slight delays in wound closure (data not shown), buthair follicle neogenesis was markedly decreased. Quantitation of Fgf9levels indicated that Fgf9 was consistently negligible in the Tcrd−/−mice.

As shown in FIG. 18, 8 wk and 40 wk−/− mice exhibited profound defectsin HFN, with reductions of >80% in HF numbers compared with wt mice(18A,B, Table 2). Thus, reduced numbers of HFs in −/− mice reflect atrue defect in hair follicle neogenesis rather than delayed kinetics ofresponse.

The above findings supported the hypothesis that activation of DETCsfollowing wounding leads to FGF9 production and subsequent hair follicleneogenesis. Nevertheless, to address the concern that DETCs may have arole in hair follicle neogenesis other than the production of FGF9,mutant (lck-cre×Fgf9^(flox/flox)) mice carrying a deletion of the FGF9gene specifically in T cells, including DETCs, were analysed for hairfollicle neogenesis following wounding. Quantitative rtPCR analysesshowed that these mice express low constitutive levels of FGF9 in skin.(FIG. 22). Wounding studies showed that these mutant(lck-cre×Fgf9^(flox/flox)) mice exhibited a dramatic reduction inpost-wound hair follicle numbers comparable to that observed in TCRd−/−animals (FIG. 18E, Table 2).

Taken together, the above described results show that DETCs areessential immunologic contributors to HF neogenesis through theproduction of FGF9.

In summary, we discovered that DETCs are the source of FGF9. Further,the findings indicate that more divergent cellular & molecular eventscould be implicated in HFN after wounding, not exactly therecapitulation of embryonic development, and provide additional evidencethat acquired immune system including DETCs would have a role in tissueregeneration.

FGF9 and DETCs are critical for HFN after wounding. Overexpression ofFGF9 in reepithelized epidermis resulted in increase of hair follicleformation. These results show that manipulation of FGF9 expressionduring wound healing or after reepithelization could be a usefulapproach to develop a new treatment for hair loss.

Example 9 Hedgehog Stimulates Hair Follicle Neogenesis by CreatingInductive Dermis During Murine Skin Wound Healing

Activation of the Sonic hedgehog (Shh) pathway reinstalls a regenerativedermal niche, called dermal papilla, which is required and sufficientfor HF neogenesis (HFN). Epidermal Shh overexpression or constitutiveSmoothened dermal activation results in extensive HFN in wounds thatotherwise end in scarring. While long-term Wnt activation is associatedwith fibrosis, Shh signal activation in Wnt active cells promotes thedermal papilla fate in scarring wounds. These studies demonstrate thatmechanisms of scarring and regeneration are not distant from one anotherand that wound repair can be redirected to promote regenerationfollowing injury by modifying a key dermal signal.

Methods

Mice.

All animal protocols were approved by the Institutional Animal Care andUse Committee (IACUC) at NYU School of Medicine. All mice with propergenotype were used for the designed experiments regardless of sex.LSL-Shh mice in which mouse Shh is expressed under the control ofβ-actin promoter upon Cre medicated excision of stop sequence, werepreviously generated as described in Wang et al. Axin2-CreER59 andβ-catenin fl(ex3) were obtained from indicated researchers. Gli1-LacZ(008211), R26-SmoM2 (005130), K14-CreER (005107), Shh fl/fl (004293),Pdgfra-CreER (018280), Smofl/fl (004526), SM22-rtTA (006875), tetO-Cre(006224), Wls fl/fl (012888), Axin2-LacZ (009120) and R26-Tomatoreporter mouse (007908), were purchased from the Jackson laboratory.

To induce CreER activity, tamoxifen (TAM) treatment was performed byintraperitoneal injection (0.1 mg per g body weight) of a 20 mg per mlsolution in corn oil. To induce rtTA activity, mice were administereddoxycycline-containing chow (20 g per kg, Bio-Serv).

Wound Experiment.

Wound experiments were carried out with 3-4-week-old or 7-8-week-oldmice as described in Ito et al. All wounding experiments were performedafter anesthetization of mice with isoflurane. Briefly, for fullthickness large wound, 1 cm2 (1×1 cm) or 2.25 cm2 (1.5×1.5 cm) of skinwere excised for 3-4-week or 7-8-week-old mice, respectively. For smallwound, skin was excised by 4 mm full-thickness biopsy punch (AcudermInc.) as published. For loss of function study of Hh pathway, woundswere harvested at PW21d by which the number of neogenic HFs wassaturated in control wounds. For gain of function study of Hh pathway,samples were harvested around 30 days after wounding (PW30d˜) to allowcontinuous formation of neogenic HFs.

Whole-Mount HFN Assay.

Whole-mount HFN assay to detect K17+ hair follicles and AP+DP wasperformed. To analyze hair follicle (dermal papilla and follicularepithelium) regeneration after wounding, wounded skin was harvested fromthe mice and incubated in 5 mM or 20 mM EDTA in PBS at 37° C. for 30 min˜2 h or overnight. The epidermis was gently separated from the dermisunder a dissecting microscope (Axiovision Discovery V12, Zeiss,Germany). Both epidermis and dermis were fixed in 4% paraformaldehydefor 10 min at room temperature (RT) and rinsed with PBS. For theepidermis, standard DAB immunohistochemistry (see below) was performedwith anti-K17 antibody (ab) (Abcam, 1:500). For the dermis, AP stainingwas performed. Dermis was incubated in NTMT solution (100 mM NaCl, 100mM Tris-Cl (pH 9.5), 50 mM MgCl2, 0.1% Tween-20) for 10 min and thenincubated in NTMT containing in NBT/BCIP (Roche, 1:50) solution at RTuntil color was visualized.

Histochemistry.

Immunohistochemistry was performed as published. For paraffin sections,tissues were fixed in 4% PFA at 4° C. overnight and rinsed with PBS.Following sequential dehydration in ethanol and xylene, tissues wereinfiltrated by paraffin and embedded in fresh paraffin. Theparaffin-embedded tissue blocks were chilled on ice for 10-15 min andcut at 6 μm thickness. The 6 μm tissue slices were flattened out on warmwater and placed on microscope slides and dried out at 37° C. overnight.The tissue sections were rehydrated through xylene and graded series ofethanol (2×100%, 90%, 80%, 70%, and 50%) and rinsed with PBS. Afterantigen retrieval in Tris-EDTA (pH 8.0), the tissue sections wereincubated with blocking solution (10% BCS in PBS containing 0.1%Tween-20) for 1 h at RT then appropriate primary antibodies at RT for 2h or 4° C. overnight. After PBS washing, the tissue sections wereincubated with secondary antibodies at RT for 1 h. If necessary, thesecond and third primary antibodies were used on the same tissuesections with corresponding secondary antibodies. Following PBS rinsing,the stained slides were mounted with mounting medium and stored at 4° C.for analysis. For frozen section, tissues were fixed in 4% PFA on icefor 10 min and embedded in OCT compound on dry ice. The frozen blockswere cut at 10 μm thickness, placed on microscope slides, and dried outat RT. After PBS washing, the tissue sections were incubated inblocking, primary, and secondary ab solutions as described above. Allimmunohistochemical analysis was observed and photographed on an uprightNikon Eclipse Ti or Zeiss Axiophot microscopes. Following antibodieswere used: rabbit anti-K17 (1:500, Abcam), rabbit anti-Lef1 (1:100, Cellsignaling), rabbit anti-Noggin (1:100, Abcam), rabbit anti-RFP (1:500,Rockland), rabbit anti-Shh (1:50, Santa Cruz), rabbit anti-SMA (1:100,Thermo Scientific), rabbit anti-F4/80 (1:100, Cell signaling), chickenanti-K14 (1:500, BioLegend), mouse anti-β-catenin (1:500, Sigma), mouseanti-SM22α (1:100, Abcam), mouse anti-AE13 (1:20, a gift of T. T. Sun),mouse anti-AE15 (1:20, a gift of T. T. Sun), mouse anti-K15 (1:100,NeoMarkers), and rat anti-CD34 (1:50, BD Bioscience). For histology,paraffin sections were stained with hematoxylin and eosin in accordancewith a general method. To detect collagen protein, trichrome stainingand picrosirius red staining were carried out using Masson's TrichromeStain Kit and Picrosirius Red Stain Kit, respectively (Polysciences).Trichrome staining was performed at NYUMC experimental pathology core.

X-Gal Staining.

X-gal staining was performed as published. Skin wound tissues were fixedin 4% PFA at 4° C. for 30 min and rinsed with PBS. The tissues wereincubated in X-gal rinse buffer (2 mM MgCl2, 0.01% Sodium deoxycholate,and 0.02% NP-40 in PBS) for 10 min at RT and then in X-gal(5-bromo-4-chloro-3-indolyl-β-d-galactopyranoside) staining buffer (0.7mg/ml X-gal, 0.5M K4Fe(CN)6 and 0.5M K3Fe(CN)6 in X-gal rinse buffer) atRT or 37° C. until color was visualized. The tissues were photographedin whole mount using a dissection microscope (Zeiss, Discovery V12). Thetissues were then dehydrated in standard graded series of ethanol,embedded in paraffin blocks and cut into 6-μm-thick sections. Tovisualize nucleus, the tissues were counterstained with nuclear fast redsolution. Small wounds of Axin2-LacZ mice were incubated in 20 mM EDTAin PBS at 37° C. for 1 h to separate dermis from epidermis before X-galstaining.

RNA-Seq Analysis.

Skin wound tissues (PW11d) of control and K14-CreER; LSLShh mice wereincubated in 20 mM EDTA solution at 37° C. for 30 min. After separationof epidermis from dermis, total RNA was isolated from epidermis anddermis using RNeasy Plus Micro-Kit (Qiagen) as described by themanufacturer. Total RNA was provided to Genome Technology Center at NYULangone Medical Center for preparing RNA-seq libraries and sequencing.RNA-seq libraries were prepared using the Illumina TruSeq Stranded TotalRNA library prep, after ribodepletion with Ribozero Gold kit (Illumina)starting from 200 ng of DNAse I treated total RNA, following themanufacturer's protocol (15 cycles of PCR amplification). The amplifiedlibraries were purified using AMPure beads, quantified by Qubit andQPCR, and visualized in an Agilent Bioanalyzer. The libraries werepooled equimolarly, and sequenced on two lanes of an Illumina HiSeq 2500flow cell, v4 chemistry as paired-end. The differentially expressedgenes (DEG) were submitted to DAVID for GO term analysis. Top relatedenriched terms were selected and shown in the figures.

Single-Cell RNA-Seq Analysis.

Skin wounds were collected from of both SM22-rtTA; tetO-Cre;R26-SmoM2/Tomato (SM22-SmoM2) and SM22-rtTA; tetO-Cre; R26-Tomato(control) mice 3 days after complete re-epithelialization (dox treatmentfrom PW1d to PW12d) and incubated in 20 mM EDTA solution at 37° C. for30 min to separate dermis from epidermis. The separated dermis wasincubated in Dulbecco's Modified Eagle Medium (DMEM, Corning) containing10% FBS (Corning) and 0.35% type I collagenase (Worthington) at 37° C.for 1 h. After rinsing with PBS, Tomato+ cells from isolated dermalcells were sorted with a FACSAria II cell sorter (BD biosciences).scRNA-seq libraries were prepared using the following: Single-Cell 3′Reagent Kits v2: Chromium™ Single-Cell 3′ Library & Gel Bead Kit v2PN-120237, Single-Cell 3′ Chip Kit v2 PN-120236, i7 Multiplex KitPN-120262″ (10× Genomics) and the Single-Cell 3′ Reagent Kits v2 UserGuide (Manual Part # CG00052 Rev A). Libraries were run on an IlluminaHiSeq 4000 as 2×150 paired-end reads, one full lane per sample, forapproximately >90% sequencing saturation. Sequencing results weredemultiplexed and converted to FASTQ format using Illumina bcl2fastqsoftware. The Cell Ranger Single-Cell Software Suite was used to performsample demultiplexing, barcode processing, and single-cell 3′ genecounting. The cDNA insert was aligned to the mm10/GRCm38 referencegenome. Only confidently mapped, non-PCR duplicates with valid barcodesand UMIs were used to generate the genebarcode matrix. Further analysisand visualization was performed using Seurat, an R package containingimplementations of commonly used single-cell analytical techniques,including the identification of highly variable genes, dimensionalityreduction, standard unsupervised clustering algorithms, and thediscovery of differentially expressed genes and markers.

Quantitative Reverse Transcription PCR (qRT-PCR).

Total RNA was isolated using RNeasy Micro-Kit (Qiagen) as described bymanufacturer and reversetranscribed with Superscript III First StrandSynthesis System (Invitrogen) for cDNA synthesis. cDNA was amplifiedusing taqman probes and the ABI 7900HT SDS system. Transcripts werequantified relative to the housekeeping gene, GAPDH.

Hydroxyproline Assay.

To measure collagen content, hydroxyproline assay kit (Sigma) was usedaccording to manufacturer's protocol. Whole wound tissues were collectedand homogenized in 100 μl of water per 10 mg tissue. After adding 100 μlof HCl (˜12 M) per 10 mg tissue into the homogenized tissue, the mixturewas hydrolyzed at 120° C. for 3 h. A total of 1-2 μl of supernatant wasincubated in 100 μl of Chloramine T/Oxidation buffer mixture for 5 minand then, in 100 μl of diluted DMAB reagent for 90 min, sequentially.The absorbance was measured at 560 nm using SpectraMax M3 (MolecularDevices).

Transmission Electron Microscopy.

Transmission electron microscopy (TEM) was carried out in MicroscopyLaboratory at NYU Langone Medical Center. The harvested wounds weredissected (0.5×1 cm) and put the wounds on top of paper tower. The skinwounds were fixed in the fixative containing 2.5% glutaraldehyde, and 2%paraformaldehyde in 0.1M sodium cacodylate buffer (pH 7.2) with 1%tannic acid for 30 min and further dissected to 1×3 mm smaller pieces.Fixation process was continued in the same fixative at RT for 2 h, then4° C. overnight. The skin then post-fixed with 1% osmium tetroxide for 2h at RT, block staining in 1% uranyl acetate overnight at 4° C., thendehydration in a standard manner and embedded in EMbed 812 (ElectronMicroscopy Sciences, Hatfield, Pa.) for transmission electronmicroscopy. Semi-thin sections were cut at 1 mm and stained with 1%Toluidine Blue to evaluate the orientation of the sample. Ultrathinsections (60 nm) were cut, mounted on copper grids and stained withuranyl acetate and lead citrate. Stained grids were examined underPhilips cm-12 electron microscope (FEI; Eindhoven, The Netherlands) andphotographed with a Gatan (4k X2.7 k) digital camera (Gatan, Inc.,Pleasanton, Calif.).

Statistical Analysis and Image Processing.

The whole-mount HFN assay was performed with at least three woundsamples per genotype, and the data were representative of over threeindependent experiments. Data were represented as mean±s.d. To calculatep-values, Student's t-test was used on Microsoft Excel, with two-tailedtests and unequal variance. All graphs were generated by Microsoft Exceland GraphPad Prism. Images were processed using Image J and AdobePhotoshop. For transforming AP signals into colored dots usingPhotoshop, images of AP staining of wound were first turned into blackand white, reduced background, and changed into red, green or cyancolors. Three images were then merged by overlapping the center of eachwound.

Data Availability.

RNA-seq data and scRNA-seq have been deposited in the Gene ExpressionOmnibus (GEO) database under accession codes GSE94893 and GSE112671,respectively.

Results

Shh Signaling is Essential for Wound-Induced HF Neogenesis.

In analyzing the disparate healing responses in large and small woundsin adult mice, it was found that Gli1 expression, a readout of Hhpathway activation, was localized to the center of large wounds,corresponding to regions of hair placode/germ formation. In strikingcontrast, it was absent from small wounds (FIG. 23a ). The Gli1 signalin large wounds localized to both DP and epithelial hair germ cells,recapitulating the pattern observed in embryonic HF development.

Moreover, Shh, a major ligand of the pathway, was upregulated at thesite of HFN in the epithelial compartment in large wounds but absentfrom either epidermal or dermal compartment in small wounds (FIG. 23b, c). Shh expression during hair follicle morphogenesis is conservedbetween mice and humans and vital for hair follicle development and haircycle. The absence of Hh pathway activation in mouse small wounds canexplain their failure to undergo regenerative wound healing during woundrepair.

First, to understand the importance of epithelial Shh expression inlarge wounds, Shh was genetically deleted from epidermal cells in healedlarge wounds of K14-CreER; Shh fl/fl mice upon tamoxifen (TAM) inductionfrom post wound (PW)3d to PW21d. This resulted in a loss of DP and hairgerm formation compared to control mice (FIG. 23d-f ). These resultsshowed that epithelial Shh ligands are essential for DP formation andHFN. Additionally, deletion of Smo, an essential component of Shhpathway activation, in underlying wound dermal cells in TAM treatedPdgfra-CreER; Smo fl/fl mice also resulted in inhibition of DP formationand associated HFN events (FIG. 23g-j ). Thus, activation of the Shhsignaling pathway in the wound dermis plays a vital role in promoting DPformation.

Epithelial Shh Leads to HF Neogenesis in Wounds.

To determine if Shh activation could induce HFN in scar-forming wounds,Shh was overexpressed in epithelial cells in K14-CreER; LSL-Shh orK14-CreER; LSL-Shh; Gli1-LacZ mice and HFN was examined in small wounds.To induce Shh overexpression, TAM was injected into control andK14-CreER; LSL-Shh or K14-CreER; LSL-Shh; Gli1-LacZ mice from PW1d toindicated time points in FIG. 24. This treatment resulted in extensiveHFN in wounds compared to control wounds (FIG. 24a, b ). Epidermal Shhoverexpression resulted in Gli1 activation in both the epidermis anddermis, corresponding to the areas of HFN. Shh-driven hair germsexpressed Lef1 and K17 and exhibited normal hair follicle morphogenesis.AP+ DPs were associated with overlying K17+ epithelial buds as typicallyobserved in HFN. Eventually, many of these hair follicles (52±16%,mean±s.d.) grew downward to form mature hair follicles with hair shafts,an event rarely observed in control small wounds. New DP expressed Lef1and Noggin as well as AP, further demonstrating their DP identity.Aberrant basaloid growths resembling superficial basal-cell carcinomas(BCCs) were rarely in these wounds.

Previous studies noted that HFN in large wounds in WT mice was limitedto the central area of the wounds. Given the ability of Shh to induceectopic HFN in small wounds, exogenous Shh might overcome the inabilityof new hair follicles to form outside this central region in largewounds. In large wounds from TAM-treated K14-CreER; LSL-Shh mice,extensive DP formation was observed covering the entire wound areacompared with TAM-treated controls. (FIG. 24c-e ). These results verifythe potency of Shh activation to overcome regional inhibition of HFN.

To characterize changes in gene expression following Shh overexpression,TAM was administered into control and K14-CreER; LSL-Shh mice from PW1dto PW11d and wound cells isolated for RNA-seq analyses. Epidermal anddermal cells from TAM-treated control and K14-CreER; LSL-Shh mice werecompared by RNA-seq analyses (FIG. 24f, g and Table 1). Gene ontology(GO) analyses showed that processes and signatures involved in embryonicHF morphogenesis, including cell proliferation, cell adhesion, and Hhsignalingl, were enriched by Shh overexpression. There was nosignificant difference in expression of Fgf9, which is known to promotehair follicle neogenesis in a large wound model, either in the epidermis(FDR:0.64) or dermis (FDR:0.97) of K14-CreER; LSL-Shh mice compared tocontrols. Most notably, there was upregulation of the Shh signalingpathway in both the epithelial cells and dermal cells. Upregulation ofDP signature genes Bmp7, Enpp2, lamc3, and Trpsl in the wound dermis andhair placode signature genes, including Trp73, Vwa2, Samd5, Cxcll4,Nedd9, and Tnfaip3 were observed in the wound epidermis of Shhoverexpressed mice. These data were confirmed by qPCR analyses. Theseresults suggest that epidermal Shh overexpression can induce keyembryonic signatures of HF morphogenesis.

Epithelial Shh Regenerates HFs without Altering Neighboring Collagen.

Although the increased collagen I deposition by adult dermal fibroblastsvs. fetal fibroblasts during wound healing is well-established, whetherthe low level of collagen I is essential for embryonic/neonatalnon-scarring healing is currently unknown.

Our RNA-seq indicates that epithelial Shh overexpression did notsignificantly change the overall extracellular matrix composition of thewound dermis towards an embryonic state. The increased ratio of type IIIversus type I collagen is a key characteristic of fetal scarless woundhealing, and expressions of the genes encoding these collagens wereunchanged (FDR: 0.99 for Col1a1, Col1a2, and Col3a1) (Table 1). This wasverified by biochemical measurement for the content of hydroxyproline, amajor component of collagen (FIG. 24h ). In addition, transmissionelectron microscopy (TEM) analysis of the wound area showed no change incollagen fiber diameter due to Shh overexpression, which is directlyproportional to the tensile strength (FIG. 24i ). Consistently, nosignificant differences were noted in the histological assessments forcollagen staining (i.e., Masson trichrome and Picrosirius red staining)before and after the formation of neogenic hair follicles (FIG. 24j, k). It was found that the epithelial Shh expression and the reduction oftype I collagen in the neighboring wound scar does not play asignificant role in Shh-driven HF neogenesis. The data indicates that DPand hair follicles were forming within the scar of the wounds.

TABLE 1 Comparison of Hh pathway component and collagen expressionbetween K14-Shh and control mice based on RNA-seq Genes Fold change FDRDermis Hh pathway Shh 2.41 0.64 Gli1 3.20 0.16 Gli2 4.18 0.06 Ptch1 3.960.03 Collagen Colla1 0.95 0.99 Colla2 1.00 0.99 Col3a1 0.94 0.99Epidermis Hh pathway Shh 51.83 2.01E−04 Gli1 4.21 1.33E−01 Gli2 7.278.65E−07 Ptch1 3.74 3.08E−04 Collagen Colla1 0.56 0.56 Colla2 0.82 0.87Col3a1 0.86 0.91

Dermal Hh Activation Induces HF Neogenesis in Scarring Wounds.

To ask if direct Shh pathway activation of myofibroblasts in the smallwound dermis would also promote DP formation and HFN, expression of theactivated form of Smo was induced under the control of the SM22αpromoter, known to be specifically active only in dermal myofibroblasts(SM22-rtTA; tetO-Cre; R26-SmoM2) (FIG. 25a ). In the transgenic mice,constitutively active Smo expression is dependent on doxycycline (dox)administration.

Expression of the activated form of Smo in myofibroblasts duringwounding (dox treatment from PW1d to PW30d) or followingre-epithelialization (dox treatment from PW10±2d to PW46d) resulted inDP formation within small wounds of SM22-SmoM2 mice compared to controlmice (FIG. 25b, c ). Constitutive Hh activation in wound myofibroblastsfrom SM22-SmoM2 mice also resulted in striking changes in woundepithelial cells. Those epithelial cells directly above Smo-active DPexpressed K17 and Shh, well established hair germ markers (FIG. 25 d, e,i). Additionally, these hair germ cells displayed nuclear β-catenin andLef1 expression indicating active Wnt signaling, a known signature ofhair follicle development and growth (FIG. 25h, j-m ). A significantnumber of new hair follicles were also observed with differentiated hairshafts (28±7%) containing both outer root sheath (AE13+ hair cortex,AE15+ medulla), and inner root sheath (AE15+) structures, stem cellcompartments (K15+CD34+), hair matrix cells (Shh+) (FIG. 25g, n ).Neogenic hair follicles also maintained an adjoining dermal sheath(SMA+, SM22α+), biochemically distinct from DP (Noggin+). AP+DPstructures were frequently observed without accompanying hair germsdespite their close proximity to overlying epidermis (FIG. 25j ).Indeed, there were almost twice as many AP+DP as K17+ hair germs,indicating that many DP (42±15%) formed without establishingepithelial-mesenchymal interactions that could promote HF morphogenesis(FIG. 25f ). DP formation without hair germ formation is not observed innormal endogenous hair follicle development in embryo or in adult largewounds. These regenerative events were observed following wound closure.

Intriguingly, even in the experiments where Hh activation was inducedearly during wound healing, the time of wound closure, proliferation,epidermal differentiation, AP distribution, angiogenesis andinfiltration of immune cells including macrophages into the wound sitewere not altered prior to wound closure.

Hh Activation Shifts Dermal Fibroblast Fate Toward DP.

To understand whether SM22+ dermal cells universally induce the DP fateupon Hh activation, Tomato+ cells were isolated from wound dermis ofSM22-rtTA; tetO-Cre; R26-SmoM2/Tomato (SM22-SmoM2) and SM22-rtTA;tetO-Cre; R26-Tomato (control) mice 3 days after completere-epithelialization (dox treatment from PW1d to PW12d) and comparedtheir molecular signatures by single-cell RNA sequencing (scRNA-seq)(FIG. 26). Unsupervised clustering with K means was performed based ondifferentially expressed genes (DEGs), using tSNE (t-distributedstochastic neighbor embedding). Based on expression of lineage markersfor different cell types, cellular clusters of fibroblasts, musclecells, schwann cells, endothelial cells and immune cells were identified(FIG. 26a-f ). Examination of Hh pathway mediators Gli1, Gli2, Ptch1,and Ptch2 showed that Hh pathway components were mainly expressed in thefibroblast cluster (FIG. 26g ) and were largely restricted to theSM22-SmoM2 group (FIG. 26h, i ). This is consistent with the lack ofGli1-lacZ expression in the wild-type dermis of small wounds (FIG. 23a). The Hh-active fibroblast clusters showed upregulation of DP signaturegenes including Hey1, Sema6a, Wif1, Cxcr4, Ggta1, Hck, Snrpn and Rasd1as previously defined by several groups (FIG. 26j ), indicating that Hhactivation in SM22+ myofibroblasts are sufficient to globally induceupregulation of DP signature genes. Nonetheless, within thisHh-activated fibroblast population, a divergence was identified in thenumber and level of DP signature genes (Hh-active I and II), indicatingthat Hh-independent mechanisms are also involved in the regulation of DPsignature genes. For example, while the upregulation of Bmp3 and Plk2,known DP signature genes, was widely observed among Hh-activefibroblasts (Hhactive I and II), expression of Alpl (AP) and Lef1, vitalmarkers for DP identification in histochemical analyses, was limited toa small subpopulation of Hh-active fibroblasts (Hh-active II) (FIG. 26j).

Hh Activation in Wound Epidermis Forms BCC-Like Structure.

In contrast to dermis-specific activation of the Hh pathway, forced Hhactivation solely in epithelial cells (K14-CreER; R26-SmoM2, TAMadministration from PW1d to PW30d) did not promote DP formation in thewound area. As previously observed, the epidermis of these woundsmaintained numerous K17+ epithelial invaginations resembling BCCswithout signs of hair follicle differentiation. Also, the Hh driven,BCC-like epithelial growths were not accompanied by underlying DP52.

Hh Activation Converts Wnt-Active Wound Fibroblasts into DP.

Next, given that Wnt signaling plays an essential role in hair follicledevelopment and neogenesis, the relationship between Wnt and Shhsignaling was examined. Our scRNA-seq analyses in myofibroblasts andexamination of Axin2 expression in wounds from Axin2-LacZ mice bothshowed Wnt activity in scarring dermis of small wounds. scRNA-seqanalyses demonstrated the expression of Axin2, Wls, and canonical Wntligands such as Wnt2 and Wnt10a (FIG. 27a, b ). These findings areconsistent with previous reports that long-term Wnt signaling withindermal fibroblasts correlates with injury-induced fibrosis. It washypothesized that dermal Wnt signaling is not sufficient to induce HFNwithout Hh activation. Indeed, constitutive activation of Wnt signaling(SM22-rtTA; tetO-Cre; β-catenin ex3/fl) in SM22+ dermal cells of smallwounds did not promote new DP regeneration or HFN (FIG. 27c-h ).However, dermal depletion of Wls, which is essential for Wnt ligandsecretion, inhibited HFN in large wounds (SM22-rtTA; tetO-Cre; Wls fl/fland dox treatment from PW3d to PW21d). These results indicate therequirement of dermal Wnt ligands for HFN (FIG. 27i -1). A studyperformed to test whether Hh activation in dermal cells was capable ofconverting Wnt-active dermal fibroblasts to the DP fate. Forced Hhactivation was induced in Wnt responsive cells within small wounds,using the promoter of Axin2, a well established target of canonical Wntactivity (Axin2-CreER;R26-SmoM2). TAM was administered into control andAxin2-CreER; R26-SmoM2 from PW1d to PW30d. Smo overexpression inWnt-active myofibroblasts resulted in extensive DP formation in smallwounds (FIG. 28a-d ). Genetic tracing of Axin2+ cells during HFN inreporter Axin2-CreER; R26-Tomato mice showed tomato expression in denovo DPs establishing that Axin2+ cells in wounds form DPs (FIG. 28e ).In contrast, control wounds without Hh activation in Wnt-active dermalcells underwent scarring without HFN (FIG. 28a-d ). These results showthat Hh activation in Wnt-active dermal cells promotes their fateconversion into DP, the regenerative dermal niche for HF formation.

The results demonstrate that wound repair can be redirected to promoteregeneration following injury by modifying a key dermal signal (FIG. 28f). This study provides definitive evidence for a longheld concept thatdermal cells are key components in determining wound healing outcome.The results show that the suppression of skin appendage regeneration inwound healing is due to the absence of dermal regeneration signalsrather than intrinsic lack of regenerative competence in scarring cells.Installing developmental signals in the wound dermis may be a reasonablestrategy to achieve regenerative healing in mammals. Epithelialactivation of Wnt and Shh signaling was previously identified ascritical for hair regeneration; however, these same pathways may alsoinduce skin epithelial cancers when experimentally or pharmacologicallyaugmented. This basic study with preclinical mouse models shows that thecapacity to create ectopic de novo DP in vivo by modulation of specificsignals in the dermis may overcome this barrier and bring us closer totrue skin renewal after injury.

Fibrotic scarring and epimorphic regeneration are frequently consideredto be on opposite ends of the wound healing spectrum. This conceptunderpins attempts to promote regenerative healing by suppression ofscarring mechanisms. This study shows that scarring/fibrosis in skinwounds may not affect HF morphogenesis if the appropriate regenerativeques are applied.

Although long-term activation of Wnt signaling, a hallmark of fibroticrepair, was observed in small wounds, the physiological level of Wntsignaling in scarring wounds did not negatively impact HFN in thepresence of Shh activation. These studies provide evidence that fibroticrepair can be genetically subverted and offers possible tools to bypassextensive reprograming of adult skin cells into an “embryonic status” orfor “stem cell transplantation” strategies to lead to regenerativehealing in mammals.

HFN is largely a recapitulation of hair follicle development. However,the requirements for Shh regulation may be different in embryonic HFdevelopment and adult HFN. Shh-null mice can develop DP16 and Smo isdispensable for the initial establishment of DP in embryos. Similarly,while epithelial Wnts are sufficient for embryonic HF development, bothepithelial and dermal Wnts are needed for adult HFN. The absoluterequirement for Shh/Smo signaling in adult de novo DP formation mayreflect a vulnerability in regeneration mechanisms compared toorganogenesis in the embryo, whose development is often ensured byredundant compensatory mechanisms.

In conclusion, this study demonstrates that de novo DP can be created inadult skin by modulating a signaling pathway in the dermis.

Example 10 Effect of Shh in Multiple Hair Regeneration Assays

Shh agonist, Hh-Ag, promotes hair neogenesis in the following models:(1) wound induced hair neogenesis; (2) patch assay of cultured mouse andhuman dermal cells; and (3) in vitro organoid culture.

As shown in FIG. 29, C57B6, wounded at P21, followed by subcutaneousinjection of Hh-Ag from PWD5 to PWD8 increases hair follicle formation.

As shown in FIG. 30, cultured human and mouse dermal cells treated withShh agonist (i.e., Hh-Ag) showed increased hair follicle (HF) number,relative to control.

FIGS. 31 and 32 show that mouse dermal cells infected with active Smovirus at PO and P2 result in more HF in recon assay. Cultured mousedermal cells transduced with Smo plus mouse epi. P2 cells typically loseactivity as seen in control. Smo transduction maintains inductivity.

DP and DS cells in HFs are made from cultured dermal cells (RFP+)infected with activated Smo. (See FIG. 33).

FIG. 34 shows quantitation of recon assay of cultured mouse dermal cellstreated with Shh Ag or infected with active Smo virus. Number of hairformed per assay was significantly higher in Shh agonist, Hh-Ag, treatedcells, relative to control and Smo virus infected cells.

Foreskin dermal cells were infected with active Smo. As shown in FIG.35, human foreskin dermal cells have no hair inducing activity butactivated smo induces them to promote HF formation.

FIG. 36 shows dose dependent response. High concentration of Hh-Aginhibited HF formation.

Mouse neonatal dermal cells were cultured from PO to P2 (See FIG. 37).Hair follicles were quantified in recon assay using cultured mouseneonatal dermal cells (See FIG. 38). FIG. 39 shows cultured dermal cellsfrom Gli1-Lacz mouse. The percentage of Gli1-Lacz positive cellsdecreased in culture even in the presence of Hh-Ag (See FIG. 40).Culturing dermal cells in the presence of Hh-Ag does not maintain theShh responding population. 24 hr Shh treatment showed fewer Gli1positive cells but had similar number of HFs in patch assay compared to7 day treatment.

Organoids were cultured. Dermal and epidermal cells from neonatal miceharvested. 5000:500 dermal:epidermal cells per well in 2 96 welllow-attachment plates. They were cultured in GMEM with: 1.5% SerumReplacement, 1× Sodium Pyruvate, 1× MEM NEAA, lx 2-Mercaptoethanol, 1×Anti-Anti, 1× GlutaMAX, 1× FGF, and 2% Matrigel. Five days later,organoid development was noticed. In one plate, 10 μM CHIR was added.CHIR is a GSK-3 inhibitor, preventing GSK-mediated phosphorylation andsubsequent degradation of β-catenin, activating the WNT-pathway. Theother plate was kept under the same conditions as before.

Differentiation medium was replaced with maturation medium under 3different conditions: nothing, SHH (10 μM), CHIR (10 μM)+SHH (10 μM).The SHH pathway is implicated in hair follicle morphogenesis. The cellswere cultured in DMEM with: lx GlutμMAX, 1× Anti-Anti, and 1× N2Supplement. The medium was changed every 2 days. The experimentsincluded blank-blank, blank-SHH, blank-SHH—CHIR, CHIR-blank, CHIR-SHH,and CHIR-SHH-CHIR. FIGS. 41 and 42 show blank-blank best images andhistology, respectively. FIGS. 43 and 44 show blank-SHH best images andhistology, respectively.

Although the invention herein has been described with reference toparticular embodiments, it is to be understood that these embodimentsare merely illustrative of the principles and applications of thepresent invention. It is therefore to be understood that numerousmodifications may be made to the illustrative embodiments and that otherarrangements may be devised without departing from the spirit and scopeof the present invention as defined by the appended claims.

What is claimed is:
 1. A method of treating hair loss in a subject, themethod comprising: administering an effective amount of a sonic hedgehog(Shh) agonist to said subject, thereby treating said hair loss in saidsubject.
 2. The method of claim 1, wherein the method comprising thesteps of: wounding a region of said hair loss in said subject; andadministering said effective amount of said sonic hedgehog (Shh) agonistto the wounded area of said subject.
 3. The method of claim 2, whereinthe step wounding is performed by disrupting a dermis or an epidermis inthe region of said hair loss in said subject.
 4. The method of claim 1,wherein said sonic hedgehog (Shh) agonist is Hh-Ag.
 5. The method ofclaim 1, wherein the subject is a human.
 6. The method of claim 1,wherein the subject has hair loss.
 7. The method of claim 1, whereinsaid hair loss is due to androgenetic alopecia (AGA).
 8. The method ofclaim 7, wherein the AGA is male pattern baldness or female patternbaldness.
 9. The method of claim 1, wherein said hair loss is due toskin injury.
 10. The method of claim 1, wherein said hair loss is in thescalp or eyebrow of said subject.
 11. The method of claim 7, whereinsaid AGA is in the scalp or eyebrow.
 12. The method of claim 1, whereinsaid hair loss is in scarred skin tissue of said subject.
 13. The methodof claim 3, wherein said disrupting is performed by exposing the regionof said hair loss to a mechanical or chemical stimulus.
 14. The methodof claim 3, wherein said disrupting is performed by exposing the regionof said hair loss to radiation.
 15. A method of increasing the number ofhair follicles in a subject, the method comprising: administering aneffective amount of a sonic hedgehog (Shh) agonist to said subject,thereby treating increasing the number of hair follicles in saidsubject.
 16. The method of claim 15, wherein the method comprising thesteps of: wounding a region of said hair loss in said subject; andadministering said effective amount of said sonic hedgehog (Shh) agonistto the wounded area of said subject.
 17. The method of claim 16, whereinthe step wounding is performed by disrupting a dermis or an epidermis inthe region of said hair loss in said subject.
 18. The method of claim15, wherein said sonic hedgehog (Shh) agonist is Hh-Ag.
 19. The methodof claim 15, wherein the subject is a human.
 20. The method of claim 15,wherein the subject has hair loss.
 21. The method of claim 20, whereinsaid hair loss is due to androgenetic alopecia (AGA).
 22. The method ofclaim 21, wherein the AGA is male pattern baldness or female patternbaldness.
 23. The method of claim 20, wherein said hair loss is due toskin injury.
 24. The method of claim 20, wherein said hair loss is inthe scalp or eyebrow of said subject.
 25. The method of claim 21,wherein said AGA is in the scalp or eyebrow.
 26. The method of claim 20,wherein said hair loss is in scarred skin tissue of said subject. 27.The method of claim 17, wherein said disrupting is performed by exposingthe region of said hair loss to a mechanical or chemical stimulus. 28.The method of claim 17, wherein said disrupting is performed by exposingthe region of said hair loss to radiation.